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General NPI Number Information
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NPI Number | 1235461849
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Entity Type | Organization
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Legal Business Name | TEEN OPTION, INC.
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Dates
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Enumeration Date | 02/06/2010
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Last Update Date | 02/06/2010
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Provider Practice Location Address
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Address Line | 6432 ELKHARDT RD
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City | RICHMOND
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State | VA
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Zip | 23225-7819
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Country | US
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Telephone | 804-745-8070
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Fax | 804-745-7554
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Provider Business Mailing Address
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Address Line | 6432 ELKHARDT RD
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City | RICHMOND
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State | VA
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Zip | 23225-7819
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Country | US
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Telephone | 804-745-8070
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Fax | 804-745-7554
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Authorized Official
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Title or Position | CEO
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Name | DR. A. JOHN BAMISILE
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Credential | PH. D
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Telephone | 804-745-8070
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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 | 1528-05-001
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License Number State | VA
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