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General NPI Number Information
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NPI Number | 1710185897
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Entity Type | Organization
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Legal Business Name | PATRICK HENRY BOYS AND GIRLS PLANTATION, INC
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Dates
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Enumeration Date | 07/10/2007
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Last Update Date | 07/10/2007
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Provider Practice Location Address
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Address Line | 1617A ENTERPRISE DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-5797
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Country | US
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Telephone | 434-239-4949
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Fax | 434-239-4955
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Provider Business Mailing Address
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Address Line | 1617A ENTERPRISE DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-5797
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Country | US
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Telephone | 434-239-4949
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Fax | 434-239-4955
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. JASON WATSON
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Credential |
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Telephone | 434-376-2006
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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 | 0701003238
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003872
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003730
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License Number State | VA
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