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General NPI Number Information
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NPI Number | 1497717615
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Entity Type | Organization
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Legal Business Name | MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION
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Dates
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Enumeration Date | 04/04/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 9228 GEORGE WASHINGTON MEMORIAL HWY
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City | GLOUCESTER
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State | VA
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Zip | 23061-4162
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Country | US
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Telephone | 804-693-5068
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Fax | 804-693-7407
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Provider Business Mailing Address
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Address Line | PO BOX 269
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City | ARK
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State | VA
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Zip | 23003-0269
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Country | US
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Telephone | 804-693-5640
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Fax | 804-693-4822
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. YVONNE M WINGROVE
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Credential | M.ED.
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Telephone | 804-693-5640
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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 |
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License Number State |
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