Healthcare Provider Details

I. General information

NPI: 1528086238
Provider Name (Legal Business Name): DOMINION BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 MECHANICSVILLE TPKE SUITE 100
MECHANICSVILLE VA
23111-3698
US

IV. Provider business mailing address

6501 MECHANICSVILLE TPKE SUITE 100
MECHANICSVILLE VA
23111-3698
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-1124
  • Fax: 804-270-2090
Mailing address:
  • Phone: 804-270-1124
  • Fax: 804-270-2090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0904000405
License Number StateVA

VIII. Authorized Official

Name: MS. DIANNE ZITO HENSLEY
Title or Position: OWNER
Credential: LCSW
Phone: 804-270-1124