MEDICARE: ASCENSION BEHAVIORAL SERVICES LLC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1588216154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENSION BEHAVIORAL SERVICES LLC

Provider Business Mailing Address
First Line	:	7602 VAN HOY DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6452
Country	:	US
Telephone Number	:	252-327-9137
Fax Number	:

Provider Business Practice Location Address
First Line	:	7602 VAN HOY DR
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-6452
Country	:	US
Telephone Number	:	252-327-9137
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISS LESLIE RENEE JONES
Credential	:	LCSW, ICAADC
Telephone Number	:	252-327-9137

Provider Enumeration Date	:	07/12/2019
Last Update Date	:	02/25/2021

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