Provider Demographics
NPI:1265000327
Name:CHAMPION COMPREHENSIVE VIRTUAL SERVICES LLC
Entity type:Organization
Organization Name:CHAMPION COMPREHENSIVE VIRTUAL SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRARI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW, MSW
Authorized Official - Phone:724-812-1101
Mailing Address - Street 1:277 DAHL RD
Mailing Address - Street 2:
Mailing Address - City:CHAMPION
Mailing Address - State:PA
Mailing Address - Zip Code:15622-2077
Mailing Address - Country:US
Mailing Address - Phone:724-455-2120
Mailing Address - Fax:
Practice Address - Street 1:860 BAY VISTA BLVD S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-5947
Practice Address - Country:US
Practice Address - Phone:724-812-1101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHAMPION COMPREHENSIVE EVOLUTION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-15
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty