Healthcare Provider Details

I. General information

NPI: 1922326909
Provider Name (Legal Business Name): MIDLOTHIAN BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2010
Last Update Date: 05/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 SOMMERVILLE CT SUITE 101
MIDLOTHIAN VA
23113-6835
US

IV. Provider business mailing address

14410 SOMMERVILLE CT SUITE 101
MIDLOTHIAN VA
23113-6835
US

V. Phone/Fax

Practice location:
  • Phone: 804-897-9355
  • Fax: 804-897-9359
Mailing address:
  • Phone: 804-897-9355
  • Fax: 804-897-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SAIMA SALEEM
Title or Position: OFFICE MANAGER
Credential:
Phone: 804-897-9355