Healthcare Provider Details

I. General information

NPI: 1679510226
Provider Name (Legal Business Name): DISTRICT 19 COMMUNITY SERVICES BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 SELWOOD RD
RICHMOND VA
23234-4246
US

IV. Provider business mailing address

5012 SELWOOD RD
RICHMOND VA
23234-4246
US

V. Phone/Fax

Practice location:
  • Phone: 804-862-8002
  • Fax: 804-862-8060
Mailing address:
  • Phone: 804-275-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number0904002353
License Number StateVA

VIII. Authorized Official

Name: MS. TERESA WULF-HELLER
Title or Position: CLINICAL SERVICES DIRECTOR
Credential: LCSW
Phone: 804-862-8002