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General NPI Number Information
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NPI Number | 1235836768
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Entity Type | Organization
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Legal Business Name | PEER RECOVERY OF VIRGINIA, INC.
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Dates
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Enumeration Date | 02/15/2023
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 3903 GLOUCESTER DR
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City | HOPEWELL
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State | VA
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Zip | 23860-5340
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Country | US
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Telephone | 540-455-3217
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Fax | 804-352-5799
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Provider Business Mailing Address
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Address Line | PO BOX 304
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City | HOPEWELL
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State | VA
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Zip | 23860-0304
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Country | US
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Telephone | 804-721-7837
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Fax | 804-352-5799
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Authorized Official
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Title or Position | PRESIDENT
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Name | OWAIIAN MAURICE JONES
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Credential |
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Telephone | 540-455-3217
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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 |
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License Number State |
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