Healthcare Provider Details

I. General information

NPI: 1275333718
Provider Name (Legal Business Name): THERAPEUTIC INTERVENTION SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2025
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 MOUNT CROSS RD STE 106
DANVILLE VA
24540-4089
US

IV. Provider business mailing address

413 MOUNT CROSS RD STE 106
DANVILLE VA
24540-4089
US

V. Phone/Fax

Practice location:
  • Phone: 252-258-4783
  • Fax:
Mailing address:
  • Phone: 252-258-4783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY ADAMS
Title or Position: EXECUTIVE DIRECTOR/ OWNER
Credential:
Phone: 252-258-4362