MEDICARE: AFTER EFFECT BEHAVIORAL HEALTH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1881462604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFTER EFFECT BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	405 E LABURNUM AVE STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2134
Country	:	US
Telephone Number	:	804-274-9348
Fax Number	:	804-800-4052

Provider Business Practice Location Address
First Line	:	405 E LABURNUM AVE STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23222-2134
Country	:	US
Telephone Number	:	804-274-9348
Fax Number	:	804-800-4052

Authorized Official
Title or Position	:	CEO
Name	:	MR. EDWARD RILEY
Credential	:
Telephone Number	:	804-274-9348

Provider Enumeration Date	:	12/12/2023
Last Update Date	:	12/12/2023

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