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General NPI Number Information
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NPI Number | 1184932105
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Entity Type | Organization
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Legal Business Name | COMMUNITY BEHAVIORAL RESOURCE GROUP
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Dates
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Enumeration Date | 09/24/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 4099 FOXWOOD DR SUITE 108
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5222
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Country | US
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Telephone | 757-737-7895
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Fax |
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Provider Business Mailing Address
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Address Line | 4099 FOXWOOD DR SUITE 108
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5222
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Country | US
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Telephone | 757-737-7895
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. PAUL L BRATTON II
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Credential | MPA
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Telephone | 804-399-2681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1251
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License Number State | VA
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