Healthcare Provider Details

I. General information

NPI: 1659333045
Provider Name (Legal Business Name): LIBERTY POINT BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MONTGOMERY AVE
STAUNTON VA
24401-3968
US

IV. Provider business mailing address

1110 MONTGOMERY AVE
STAUNTON VA
24401-3968
US

V. Phone/Fax

Practice location:
  • Phone: 703-777-0822
  • Fax: 703-777-7147
Mailing address:
  • Phone: 703-777-0822
  • Fax: 703-777-7147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number78014001
License Number StateVA

VIII. Authorized Official

Name: PAT HOFFMAN
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 330-758-4515