| Doctor Name: | DORIS DORETHA CHISM |
| NPI Number: | 1790024511 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | CRF-279 |
| Business Practice Address: | 1099 Bagwell Dr Scottsburg, VA - 245892712 |
| Business Phone Number: | 4344761040 |
| Business Fax Number: | 4344761070 |
| Mailing Address: | 1099 Bagwell Dr, SCOTTSBURG |
| State: | VA |
| Postal Code: | 245892712 |
| Phone Number: | 4344761040 |
| Fax Number: | 4344761070 |
| NPI Enumeration Date: | 02/14/2013 |
| NPI Last Update Date: | 02/14/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 320800000X |
| License Number: | CRF-279 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Residential Treatment Facilities |
| Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |