49D2156753 CLIA NUMBER - DISTRICT 19 COMMUNITY SERVICES BOARD

Laboratory Demographics

  • CLIA Code: 49D2156753
  • Facility Name: DISTRICT 19 COMMUNITY SERVICES BOARD
  • Facility Address: 20 W BANK STREET
    PETERSBURG, VA
    ZIP 23803
  • Facility Phone: 804 862-6082
  • Facility Type: Other - OUTPATIENT CLINIC AT CSB
  • Facility Type: Waiver
  • Lab Director: LETITIA WALLACE
  • NPI Number: 1669970646
  • Taxonomy: 252Y00000X - Early Intervention Provider Agency

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CLIA Record

Field Name Field Value
CLIA Number 49D2156753
LAB Type Other - OUTPATIENT CLINIC AT CSB
Facility Name DISTRICT 19 COMMUNITY SERVICES BOARD
Street 20 W BANK STREET
City PETERSBURG
State VA
ZIP 23803
Phone 804 862-6082
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 10/24/2024
Certificate Expiration Date 10/23/2026
Facility Type Other - OUTPATIENT CLINIC AT CSB
Lab Director LETITIA WALLACE

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This page was last updated on: 9/29/2025