Healthcare Provider Details

I. General information

NPI: 1275800765
Provider Name (Legal Business Name): DOMINION OUTPATIENT SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6767 FOREST HILL AVE SUITE 307
RICHMOND VA
23225-1856
US

IV. Provider business mailing address

6767 FOREST HILL AVENUE SUITE 307
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-2000
  • Fax: 804-272-2030
Mailing address:
  • Phone: 804-272-2000
  • Fax: 804-272-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0904007163
License Number StateVA

VIII. Authorized Official

Name: MRS. KIMBERLY HINES
Title or Position: SERVICE DIRECTOR
Credential: LCSW
Phone: 804-272-2000