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General NPI Number Information
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NPI Number | 1942909320
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Entity Type | Organization
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Legal Business Name | SUPPORTIVE THERAPEUTIC OPTIONS, LLC
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Dates
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Enumeration Date | 02/24/2023
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 43 RIVES ROAD EAST WING, SUITE B
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 571-455-9803
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Fax |
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Provider Business Mailing Address
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Address Line | 9404 SMOKEY BEAR CT
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City | BRISTOW
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State | VA
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Zip | 20136-1198
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DOMINIC JONES
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Credential |
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Telephone | 571-455-9803
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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 |
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License Number State |
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