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General NPI Number Information
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NPI Number | 1326367475
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Entity Type | Organization
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Legal Business Name | CENTER FOR BEHAVIOR MANAGEMENT
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Dates
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Enumeration Date | 05/27/2010
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 1249 BOULDER CREEK RD
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City | RICHMOND
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State | VA
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Zip | 23225-4164
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Country | US
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Telephone | 804-714-8377
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Fax | 804-525-4383
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Provider Business Mailing Address
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Address Line | 1249 BOULDER CREEK RD
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City | RICHMOND
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State | VA
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Zip | 23225-4164
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Country | US
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Telephone | 804-714-8377
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Fax | 804-525-4383
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MISS PRISCILLA ANTOINETTE WRIGHT
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Credential | LPC
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Telephone | 804-714-8377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701048009
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License Number State | VA
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