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General NPI Number Information
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NPI Number | 1780923292
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Entity Type | Organization
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Legal Business Name | ADVANCED BEHAVIORAL HEALTH SERVICES, LLC
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Dates
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Enumeration Date | 02/04/2013
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Last Update Date | 02/04/2013
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Provider Practice Location Address
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Address Line | 1241 MALL DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4879
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Country | US
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Telephone | 804-539-2557
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Fax |
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Provider Business Mailing Address
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Address Line | 7514 VAN HOY DR
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-6454
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Country | US
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Telephone | 804-539-2557
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Fax |
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Authorized Official
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Title or Position | CEO- CLINICAL PSYCHOLOGIST
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Name | DR. ALAN THOMAS VON KLEISS
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Credential | PSYD
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Telephone | 804-539-2557
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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 | 0810004544
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License Number State | VA
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