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General NPI Number Information
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NPI Number | 1093313868
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Entity Type | Organization
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Legal Business Name | TRI COUNTIES BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 10/14/2020
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 1807 PINEY WOODS ROAD
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868
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Country | US
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Telephone | 704-351-0213
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Fax |
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Provider Business Mailing Address
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Address Line | 1807 PINEY WOODS ROAD
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City | LAWRENCEVILLE
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State | VA
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Zip | 23868
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Country | US
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Telephone | 704-351-0213
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Fax |
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Authorized Official
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Title or Position | OWNER/ MANAGING MEMBER
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Name | SHEVON NEWELL VALENTINE
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Credential |
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Telephone | 704-351-0213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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