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General NPI Number Information
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NPI Number | 1245754480
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Entity Type | Organization
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Legal Business Name | ABOVE AND BEYOND MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 07/31/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 342 CHURCH ST
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City | DANVILLE
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State | VA
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Zip | 24540-4420
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Country | US
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Telephone | 954-288-6905
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Fax |
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Provider Business Mailing Address
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Address Line | 342 CHURCH ST
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City | DANVILLE
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State | VA
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Zip | 24540-4420
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Country | US
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Telephone | 954-288-6905
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | EDNA GWYNN
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Credential |
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Telephone | 954-288-6905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | S6808093
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License Number State | VA
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