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General NPI Number Information
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NPI Number | 1275274300
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Entity Type | Organization
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Legal Business Name | BURGESS BEHAVIORAL HEALTH ALTERNATIVES, LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/11/2022
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Provider Practice Location Address
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Address Line | 740 JESSIE DUPONT MEMORIAL HWY
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City | BURGESS
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State | VA
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Zip | 22432
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Country | US
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Telephone | 804-453-3290
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Fax | 804-453-3492
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Provider Business Mailing Address
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Address Line | 110 N ROBINSON ST STE 200
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City | RICHMOND
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State | VA
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Zip | 23220-4460
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Country | US
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Telephone | 804-453-3290
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Fax | 804-453-3492
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | THARTA RENA KING
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Credential |
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Telephone | 804-787-0408
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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