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NPI Code Detail

MEDICARE: MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION

MEDICARE: MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2294721OTHERVAVALUE OPTIONS
3250204OTHERVAANTHEM
4250208OTHERVAANTHEM
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6250202OTHERVAANTHEM

General Provider Information

NPI Number : 1497717615
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION
Provider Business Mailing Address
First Line : PO BOX 269
Second Line :
City : ARK
State : VA
Zip : 23003-0269
Country : US
Telephone Number : 804-693-5640
Fax Number : 804-693-4822
Provider Business Practice Location Address
First Line : 9228 GEORGE WASHINGTON MEMORIAL HWY
Second Line :
City : GLOUCESTER
State : VA
Zip : 23061-4162
Country : US
Telephone Number : 804-693-5068
Fax Number : 804-693-7407
Authorized Official
Title or Position : CHIEF FINANCIAL OFFICER
Name : MRS. YVONNE M WINGROVE
Credential : M.ED.
Telephone Number : 804-693-5640
Provider Enumeration Date : 04/04/2006
Last Update Date : 06/21/2018

Similar Medicare Providers

1205779477 — BROOKE GALLAGHER LCSW
Practice Location Address:
9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER, VA
23061-4162
Practice Phone: 804-695-8120
Practice Fax: 804-695-8122
1679415376 — KELLY SHIFFLETT LCSW
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1184685877 — DR. PARTHIV J SHETH M.D.
Practice Location Address:
9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER, VA
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Practice Phone: 804-693-5068
Practice Fax: 804-693-7407
1144282245 — CAROLYN G. DOLAN L.P.C.
Practice Location Address:
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Practice Fax: 804-693-7407
1972565141 — JUDITH M. CATHEY L.C.S.W.
Practice Location Address:
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Practice Phone: 804-693-5068
Practice Fax: 804-693-7407
1184686750 — ELIZABETH A. CLEMMONS L.P.C.
Practice Location Address:
9228 GEORGE WASHINGTON MEMORIAL HWY
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23061-4162
Practice Phone: 804-693-5057
Practice Fax: 804-693-7407

Directions to “MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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