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General NPI Number Information
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NPI Number | 1952755597
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Entity Type | Organization
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Legal Business Name | 180 DEGREE SUPPORT SERVICES LLC
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Dates
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Enumeration Date | 04/20/2016
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Last Update Date | 11/07/2018
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Provider Practice Location Address
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Address Line | 4914 RADFORD AVENUE SUITE 308-A
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City | RICHMOND
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State | VA
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Zip | 23230-3538
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Country | US
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Telephone | 804-475-6979
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Fax |
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Provider Business Mailing Address
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Address Line | 4914 RADFORD AVENUE SUITE 308-A AND 305
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City | RICHMOND
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State | VA
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Zip | 23230
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Country | US
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Telephone | 804-475-6979
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DOUGLAS JOSHUA HOOD
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Credential |
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Telephone | 804-475-6979
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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 | 212003001
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License Number State | VA
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