Healthcare Provider Details

I. General information

NPI: 1912385642
Provider Name (Legal Business Name): HENRICO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10299 WOODMAN RD
GLEN ALLEN VA
23060-4419
US

IV. Provider business mailing address

10299 WOODMAN RD
GLEN ALLEN VA
23060-4419
US

V. Phone/Fax

Practice location:
  • Phone: 804-727-8500
  • Fax: 804-727-8580
Mailing address:
  • Phone: 804-727-8500
  • Fax: 804-727-8580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number099
License Number StateVA

VIII. Authorized Official

Name: MRS. LAURA S. TOTTY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 804-727-8585