Healthcare Provider Details

I. General information

NPI: 1528794419
Provider Name (Legal Business Name): BALANCED BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 02/01/2026
Certification Date: 02/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 TURNER RD STE O
NORTH CHESTERFIELD VA
23225-6400
US

IV. Provider business mailing address

310 TURNER RD STE O
NORTH CHESTERFIELD VA
23225-6400
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-1589
  • Fax: 804-800-7884
Mailing address:
  • Phone: 804-447-1589
  • Fax: 804-800-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: KELSEY WALTERS
Title or Position: CEO
Credential:
Phone: 540-892-0193