Healthcare Provider Details

I. General information

NPI: 1740347145
Provider Name (Legal Business Name): BEHAVIORAL AWARENESS CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 HIOAKS RD SUITE A
RICHMOND VA
23225-4043
US

IV. Provider business mailing address

681 HIOAKS ROAD SUITE A
RICHMOND VA
23225
US

V. Phone/Fax

Practice location:
  • Phone: 804-320-3626
  • Fax: 804-330-5567
Mailing address:
  • Phone: 804-320-3626
  • Fax: 804-330-5567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number0904001006
License Number StateVA

VIII. Authorized Official

Name: MS. LAUREL V. PURCHASE
Title or Position: PRESIDENT
Credential: LCSW
Phone: 804-320-3626