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General NPI Number Information
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NPI Number | 1841725926
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Entity Type | Organization
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Legal Business Name | ENVISION ONE, LLC, ARTS
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Dates
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Enumeration Date | 04/26/2017
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Last Update Date | 04/26/2017
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Provider Practice Location Address
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Address Line | 15 GOODRICH AVE
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City | PETERSBURG
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State | VA
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Zip | 23805-2119
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Country | US
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Telephone | 804-862-8300
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Fax | 804-862-8302
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Provider Business Mailing Address
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Address Line | 15 GOODRICH AVE
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City | PETERSBURG
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State | VA
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Zip | 23805-2119
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Country | US
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Telephone | 804-862-8300
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Fax | 804-862-8302
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Authorized Official
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Title or Position | CEO
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Name | ANGELA JONES
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Credential |
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Telephone | 804-862-8300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | VA
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