Healthcare Provider Details

I. General information

NPI: 1528477296
Provider Name (Legal Business Name): ADJUST TO LIFE BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N ARCH RD
NORTH CHESTERFIELD VA
23236-3567
US

IV. Provider business mailing address

889 MOUNT OLIVE COHOKE RD
KING WILLIAM VA
23086-2424
US

V. Phone/Fax

Practice location:
  • Phone: 804-387-0426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2063
License Number StateVA

VIII. Authorized Official

Name: WILLIAM MICKENS II
Title or Position: PRESIDENT
Credential:
Phone: 804-387-0426