Healthcare Provider Details

I. General information

NPI: 1457598401
Provider Name (Legal Business Name): CENTRA HEALTH, INC. COMMUNITY BASED MENTAL HEALTH PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3024 FOREST HILLS CIR COMMUNITY BASED MENTAL HEALTH PROGRAMS-CARLA WARNER
LYNCHBURG VA
24501-2312
US

IV. Provider business mailing address

3300 RIVERMONT AVE COMMUNITY BASED MENTAL HEALTH PROGRAMS-CARLA WARNER
LYNCHBURG VA
24503-2030
US

V. Phone/Fax

Practice location:
  • Phone: 540-525-8447
  • Fax: 540-342-5395
Mailing address:
  • Phone: 540-525-8447
  • Fax: 540-342-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLA WARNER
Title or Position: COORDINATOR
Credential: LCSW
Phone: 540-525-8447