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General NPI Number Information
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NPI Number | 1932659976
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Entity Type | Organization
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Legal Business Name | GREENBROOK TMS MIDLOTHIAN LLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 10/13/2016
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Provider Practice Location Address
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Address Line | 2820 WATERFORD LAKE DR SUITE 201
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3994
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Country | US
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Telephone | 804-419-5780
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Fax | 804-419-5781
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Provider Business Mailing Address
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Address Line | 2820 WATERFORD LAKE DR SUITE 201
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3994
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Country | US
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Telephone | 804-419-5780
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Fax | 804-419-5781
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | BRYCE NEUMANN
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Credential |
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Telephone | 434-242-3278
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | VA
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