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General NPI Number Information
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NPI Number | 1265288500
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Entity Type | Individual
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Provider Name | JOHN CURLY BRISCO III DOCTOR
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Gender | Male
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Dates
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Enumeration Date | 04/26/2024
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 49 S MARKET ST
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City | PETERSBURG
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State | VA
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Zip | 23803-4214
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Country | US
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Telephone | 804-439-1212
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Fax |
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Provider Business Mailing Address
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Address Line | 1712 CARTER ST
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City | RICHMOND
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State | VA
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Zip | 23220-6906
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Country | US
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Telephone | 804-439-1212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710103445
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License Number State | VA
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