Healthcare Provider Details

I. General information

NPI: 1386704898
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA DEPARTMENT OF BEHAVIORAL HEALTH AND SOUTHERN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

382 TAYLOR DR
DANVILLE VA
24541-4023
US

IV. Provider business mailing address

382 TAYLOR DR
DANVILLE VA
24541-4023
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-6220
  • Fax: 434-791-5403
Mailing address:
  • Phone: 434-799-6220
  • Fax: 434-791-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. WILLIAM NEAL COOK
Title or Position: FACILITY DIRECTOR
Credential: MS, LPC
Phone: 434-773-4230