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General NPI Number Information
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NPI Number | 1194196873
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Entity Type | Organization
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Legal Business Name | NEW GROWTH BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 5825 QUIET PINE CIR
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City | CHESTER
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State | VA
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Zip | 23831-7731
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Country | US
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Telephone | 804-243-4912
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Fax |
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Provider Business Mailing Address
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Address Line | 5825 QUIET PINE CIR
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City | CHESTER
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State | VA
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Zip | 23831-7731
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Country | US
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Telephone | 804-243-4912
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ERIKA JACKSON-BAILEY
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Credential | BS, MS, LMHP/RC
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Telephone | 804-982-3107
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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 | 2598
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License Number State | VA
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