Healthcare Provider Details

I. General information

NPI: 1770402620
Provider Name (Legal Business Name): EQUINOX BEHAVIORAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9017 FOREST HILL AVE STE 2A
NORTH CHESTERFIELD VA
23235-3051
US

IV. Provider business mailing address

11160 BROKEN BIT LN
ASHLAND VA
23005-7551
US

V. Phone/Fax

Practice location:
  • Phone: 804-502-4532
  • Fax:
Mailing address:
  • Phone: 804-502-4532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: EMILY WILSON
Title or Position: OWNER
Credential: LPC, LBA, BCBA
Phone: 804-502-4532