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General NPI Number Information
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NPI Number | 1700150166
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Entity Type | Organization
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Legal Business Name | MAINSTREAM MENTAL HEALTH SERVICES, INC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 06/13/2012
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Provider Practice Location Address
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Address Line | 1616 ROANOKE RD
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City | DALEVILLE
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State | VA
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Zip | 24083-2919
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Country | US
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Telephone | 540-309-4836
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 745
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City | DALEVILLE
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State | VA
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Zip | 24083-0745
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Country | US
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Telephone | 540-309-4836
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Fax | 540-966-3470
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. MICHAEL PRESTON MORRIS
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Credential |
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Telephone | 540-309-4836
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1877-03-001
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License Number State | VA
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