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General NPI Number Information
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NPI Number | 1508598228
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Entity Type | Organization
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Legal Business Name | BEACON BEHAVIORAL HEALTH AND CONSULTING, LLC
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Dates
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Enumeration Date | 06/30/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 4914 FITZHUGH AVE STE 102
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City | RICHMOND
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State | VA
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Zip | 23230-3534
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Country | US
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Telephone | 804-551-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 1806 SUMMIT AVE SUITE 300, MAILSTOP 225
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City | RICHMOND
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State | VA
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Zip | 23230
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Country | US
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Telephone |
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Fax | 804-802-5604
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KIRBY WILLIAMS
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Credential | NP
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Telephone | 804-551-7422
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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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