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General NPI Number Information
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NPI Number | 1104170398
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Entity Type | Organization
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Legal Business Name | FREDERICKSBURG AREA HEALTH AND SUPPORT SERVICES
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 10514 WAKEMAN DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-8040
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Country | US
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Telephone | 540-907-4555
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Fax | 833-918-2314
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Provider Business Mailing Address
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Address Line | 4343 PLANK RD STE 100
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-4807
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Country | US
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Telephone | 540-907-4555
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Fax | 540-907-4318
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JOSEPH LYTTLE
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Credential |
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Telephone | 540-907-4555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #5
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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 #6
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #7
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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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Taxonomy #8
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 364SF0001X
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Taxonomy Name | Family Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #13
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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Taxonomy #14
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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