Healthcare Provider Details

I. General information

NPI: 1437352945
Provider Name (Legal Business Name): BEHAVIORAL HEALTH ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 09/18/2023
Certification Date: 09/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 YANCEY AVE
SOUTH BOSTON VA
24592
US

IV. Provider business mailing address

2082 OLD GRUBBY RD
SOUTH BOSTON VA
24592-6136
US

V. Phone/Fax

Practice location:
  • Phone: 434-575-8255
  • Fax: 434-572-1616
Mailing address:
  • Phone: 434-575-8255
  • Fax: 434-572-1616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. JANE C ROSE
Title or Position: OWNER/PROVIDER
Credential: LCSW
Phone: 434-575-8255