49D2206762 CLIA NUMBER - SHAPING YOUR FUTURE PSYCHIATRY LLC TRISHA PARKER

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Laboratory Demographics

CLIA Number: 49D2206762

Facility Name: SHAPING YOUR FUTURE PSYCHIATRY LLC TRISHA PARKER

Facility Address:
1534 BATEAU LANDING
CHESAPEAKE, VA
ZIP 23321
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Facility Phone Number: 757 528-2850

Facility Type: Mobile Laboratory

Certificate Type: Waiver

NPI Number: 1679185573

Taxonomy: 261QM0801X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D2206762
LAB Type	Mobile Laboratory
Facility Name	SHAPING YOUR FUTURE PSYCHIATRY LLC TRISHA PARKER
Street	1534 BATEAU LANDING
City	CHESAPEAKE
State	VA
ZIP	23321
Phone	757 528-2850
CertificateType	4
CertificateEffectiveDate	12/22/2022
CertificateExpirationDate	12/21/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024