Healthcare Provider Details

I. General information

NPI: 1720527518
Provider Name (Legal Business Name): GLOBAL CLINICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2017
Last Update Date: 06/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 804-225-9144
  • Fax:
Mailing address:
  • Phone: 804-225-9144
  • 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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DONNA Z PIERCE-BAYLOR
Title or Position: CAO
Credential:
Phone: 804-225-9144