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General NPI Number Information
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NPI Number | 1174411250
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Entity Type | Organization
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Legal Business Name | BALSAM BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 06/26/2025
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 913 FIRST COLONIAL RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-3198
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Country | US
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Telephone | 757-288-0442
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Fax |
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Provider Business Mailing Address
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Address Line | 540 CONSERVANCY WAY APT 105
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City | CHESAPEAKE
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State | VA
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Zip | 23323-1334
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Country | US
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Telephone | 757-288-0442
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MANDY GADDIS
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Credential | QMHP
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Telephone | 757-288-0442
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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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