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General NPI Number Information
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NPI Number | 1235557042
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Entity Type | Organization
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Legal Business Name | ORLANDO'S PLACE, LLC
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 06/10/2014
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Provider Practice Location Address
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Address Line | 4510 PLANK RD SUITE 203
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-0138
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Country | US
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Telephone | 540-412-6749
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Fax | 540-412-6750
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Provider Business Mailing Address
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Address Line | 4510 PLANK RD SUITE 203
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-0138
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Country | US
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Telephone | 540-412-6749
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Fax | 540-412-6750
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. SHIRLEY B. TAYLOR
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Credential | BA PSYCHOLOGY
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Telephone | 540-412-6749
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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 | 1890-02-006
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License Number State | VA
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