Healthcare Provider Details

I. General information

NPI: 1760565915
Provider Name (Legal Business Name): COLONIAL BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 06/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1657 MERRIMAC TRAIL
WILLIAMSBURG VA
23185
US

IV. Provider business mailing address

1657 MERRIMAC TRAIL
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-220-3200
  • Fax: 757-253-4311
Mailing address:
  • Phone: 757-220-3200
  • Fax: 757-253-4371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID A. COE
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, MBA
Phone: 757-253-4158