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General NPI Number Information
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NPI Number | 1861096679
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Entity Type | Organization
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Legal Business Name | HIS SERVICE CENTER, LLC
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Dates
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Enumeration Date | 11/23/2020
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 4808 CHATHAM GROVE PL
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1159
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Country | US
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Telephone | 804-433-8247
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Fax | 804-800-2271
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Provider Business Mailing Address
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Address Line | 4808 CHATHAM GROVE PL
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1159
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Country | US
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Telephone | 804-433-8247
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Fax | 804-800-2271
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MELANIE SUSANE JONES
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Credential | LCSW
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Telephone | 804-433-8247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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