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General NPI Number Information
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NPI Number | 1417320797
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL CONSULTING SERVICES
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 12656 LAKE RIDGE DR STE C
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City | WOODBRIDGE
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State | VA
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Zip | 22192-7504
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Country | US
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Telephone | 703-910-4362
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Fax |
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Provider Business Mailing Address
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Address Line | 12656 LAKE RIDGE DR STE C
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City | WOODBRIDGE
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State | VA
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Zip | 22192-7504
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Country | US
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Telephone | 703-910-4362
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JENNIFER SMITH
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Credential |
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Telephone | 703-232-9691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0134000133
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License Number State | VA
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