Healthcare Provider Details

I. General information

NPI: 1417147042
Provider Name (Legal Business Name): DRUG AND ALCOHOL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 W MARSHALL ST
RICHMOND VA
23230-4811
US

IV. Provider business mailing address

2926 W MARSHALL ST
RICHMOND VA
23230-4811
US

V. Phone/Fax

Practice location:
  • Phone: 804-355-8482
  • Fax:
Mailing address:
  • Phone: 804-355-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number778
License Number StateVA

VIII. Authorized Official

Name: MRS. KATIE W MALLINGER
Title or Position: DIRECTOR
Credential: LCSW
Phone: 804-355-8478