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General NPI Number Information
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NPI Number | 1649209990
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Entity Type | Organization
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Legal Business Name | DICKENSON COUNTY BEHAVIORAL HEALTH SERVICES
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 02/28/2022
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Provider Practice Location Address
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Address Line | 440 FOX TOWN RD
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City | CLINTWOOD
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State | VA
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Zip | 24228-5077
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Country | US
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Telephone | 276-926-1682
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Fax | 276-926-9179
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Provider Business Mailing Address
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Address Line | PO BOX 309
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City | CLINTWOOD
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State | VA
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Zip | 24228-0309
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Country | US
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Telephone | 276-926-1682
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Fax | 276-926-8134
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. KEVIN MULLINS
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Credential | MA
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Telephone | 276-926-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 091-07-004
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | 091-16-001
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 091-01-001
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License Number State | VA
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Taxonomy #6
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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 | 091-16-001
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License Number State | VA
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Legacy Identifiers
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Identifier #1
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Identifier Code | 542636
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | VALUE OPTIONS
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Identifier #2
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Identifier Code | 004945549
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Identifier Type | MEDICAID
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Identifier State | VA
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Identifier Issuer |
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Identifier #3
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Identifier Code | 542631
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | VALUE OPTIONS
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Identifier #4
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Identifier Code | 324879
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | TRIGON
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Identifier #5
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Identifier Code | 385241
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | TRIGON
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 004945549
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Identifier Type | MEDICAID
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Identifier State | VA
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Identifier Issuer |
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Identifier #2
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Identifier Code | 324879
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | TRIGON
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Identifier #3
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Identifier Code | 385241
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | TRIGON
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Identifier #4
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Identifier Code | 542631
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | VALUE OPTIONS
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Identifier #5
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Identifier Code | 542636
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Identifier Type | OTHER
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Identifier State | VA
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Identifier Issuer | VALUE OPTIONS
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