Healthcare Provider Details

I. General information

NPI: 1275274300
Provider Name (Legal Business Name): BURGESS BEHAVIORAL HEALTH ALTERNATIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 JESSIE DUPONT MEMORIAL HWY
BURGESS VA
22432
US

IV. Provider business mailing address

110 N ROBINSON ST STE 200
RICHMOND VA
23220-4460
US

V. Phone/Fax

Practice location:
  • Phone: 804-453-3290
  • Fax: 804-453-3492
Mailing address:
  • Phone: 804-453-3290
  • Fax: 804-453-3492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: THARTA RENA KING
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 804-787-0408