Healthcare Provider Details

I. General information

NPI: 1962736595
Provider Name (Legal Business Name): BEHAVIOR HEALTH & WELLNESS CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2009
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11824 FISHING POINT DR STE B
NEWPORT NEWS VA
23606-2679
US

IV. Provider business mailing address

3024 CONE MANOR LN
RALEIGH NC
27613-6604
US

V. Phone/Fax

Practice location:
  • Phone: 757-599-0012
  • Fax: 888-519-4656
Mailing address:
  • Phone: 510-776-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MR. MARLIN ADILI METTERS
Title or Position: PARTNER
Credential:
Phone: 510-776-3984