Healthcare Provider Details

I. General information

NPI: 1043262215
Provider Name (Legal Business Name): DOMINION BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 N COURTHOUSE RD
RICHMOND VA
23236-4069
US

IV. Provider business mailing address

703 N COURTHOUSE RD
RICHMOND VA
23236-4069
US

V. Phone/Fax

Practice location:
  • Phone: 804-639-1136
  • Fax: 804-639-5584
Mailing address:
  • Phone: 804-639-1136
  • Fax: 804-639-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT SAMUEL FALK
Title or Position: VICE PRESIDENT
Credential: PHD
Phone: 804-794-4482