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General NPI Number Information
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NPI Number | 1699397786
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Entity Type | Organization
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Legal Business Name | CARE CONNECT BEHAVIORAL HEALTH, LLC
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Dates
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Enumeration Date | 05/12/2020
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Last Update Date | 05/12/2020
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Provider Practice Location Address
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Address Line | 3520 HIGH ST STE 100
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3126
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Country | US
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Telephone | 757-237-6257
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Fax | 757-962-9368
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Provider Business Mailing Address
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Address Line | 3520 HIGH ST STE 100
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City | PORTSMOUTH
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State | VA
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Zip | 23707-3126
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Country | US
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Telephone | 757-237-6257
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Fax | 757-962-9368
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Authorized Official
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Title or Position | CEO
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Name | MR. RONALD TAYLOR
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Credential |
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Telephone | 757-237-6257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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