Healthcare Provider Details

I. General information

NPI: 1235374430
Provider Name (Legal Business Name): D19CRISIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

20 W BANK ST
PETERSBURG VA
23803-3279
US

V. Phone/Fax

Practice location:
  • Phone: 804-541-6704
  • Fax: 804-541-6708
Mailing address:
  • Phone: 804-541-6704
  • Fax: 804-541-6708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ROD TPSISTIS
Title or Position: EMERGENCY SERVICES MANANGER
Credential: LPC
Phone: 804-541-6704