Healthcare Provider Details

I. General information

NPI: 1164588570
Provider Name (Legal Business Name): PLANNING DISTRICT ONE BEHAVIORAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 06/15/2022
Certification Date: 06/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 PARK AVE SW
NORTON VA
24273-1610
US

IV. Provider business mailing address

PO BOX 1130
NORTON VA
24273-0904
US

V. Phone/Fax

Practice location:
  • Phone: 276-679-5751
  • Fax: 276-679-5754
Mailing address:
  • Phone: 276-679-5751
  • Fax: 276-679-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number315-06-001
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number315-07-004
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number315-07-004
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number315-07-004
License Number StateVA

VIII. Authorized Official

Name: MRS. SANDRA O'DELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 276-679-5751