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General NPI Number Information
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NPI Number | 1629421946
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Entity Type | Organization
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Legal Business Name | CENTRAL VIRGINIA BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 07/21/2016
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Last Update Date | 07/21/2016
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Provider Practice Location Address
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Address Line | 1213 N 24TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-5232
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Country | US
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Telephone | 804-263-6403
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Fax |
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Provider Business Mailing Address
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Address Line | 1213 N 24TH ST
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City | RICHMOND
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State | VA
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Zip | 23223-5232
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Country | US
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Telephone | 804-263-6403
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Fax |
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Authorized Official
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Title or Position | CAO
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Name | MRS. C NICOLE SIMMONS-JACKSON
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Credential | MSW
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Telephone | 804-263-6403
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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 | 001731
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 001731
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 001731
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 001731
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License Number State | VA
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Taxonomy #5
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001731
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License Number State | VA
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