MEDICARE: DOMINION DAY TREATMENT 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	101YM0800X	Mental Health Counselor	101YM0800X	VA
2	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629169016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION DAY TREATMENT LLC.

Provider Business Mailing Address
First Line	:	1640 E PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2368
Country	:	US
Telephone Number	:	804-316-6656
Fax Number	:	804-285-9839

Provider Business Practice Location Address
First Line	:	5408 CHAMBERLAYNE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-2407
Country	:	US
Telephone Number	:	804-285-9838
Fax Number	:	804-285-9839

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	EBONY COWAN
Credential	:
Telephone Number	:	804-316-6656

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	03/22/2024

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Directions to “DOMINION DAY TREATMENT LLC. ” Practice Location

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