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General NPI Number Information
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NPI Number | 1790036598
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Entity Type | Organization
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Legal Business Name | MOBILE MENTAL HEALTH LLC
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Dates
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Enumeration Date | 09/20/2012
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Last Update Date | 09/20/2012
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Provider Practice Location Address
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Address Line | 5606 VIRGINIA BEACH BLVD SUITE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5631
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Country | US
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Telephone | 757-321-8360
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Fax | 757-321-8361
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Provider Business Mailing Address
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Address Line | 5606 VIRGINIA BEACH BLVD SUITE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-5631
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Country | US
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Telephone | 757-321-8360
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Fax | 757-321-8361
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Authorized Official
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Title or Position | CEO
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Name | PAUL VINCENT CALLAHAN
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Credential |
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Telephone | 757-321-8360
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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 | 1111185297
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License Number State | VA
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