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General NPI Number Information
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NPI Number | 1003142290
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Entity Type | Organization
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Legal Business Name | ASSOCIATED BEHAVORIAL OUTCOMES AND DEVELOPMENTAL EXPERTS OF VIRGINIA
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 10/23/2009
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Provider Practice Location Address
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Address Line | 8659 STAPLES MILL RD
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City | RICHMOND
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State | VA
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Zip | 23228
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Country | US
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Telephone | 804-864-2273
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Fax | 804-726-2273
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Provider Business Mailing Address
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Address Line | PO BOX 28289
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City | RICHMOND
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State | VA
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Zip | 23228
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Country | US
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Telephone | 804-864-2273
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Fax | 804-726-2273
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Authorized Official
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Title or Position | CEO/OWNER
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Name | MR. SEBASTIAN NMI SYMEONIDES
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Credential | QMHP
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Telephone | 804-244-0802
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 97703001
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License Number State | VA
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