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General NPI Number Information
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NPI Number | 1962736595
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Entity Type | Organization
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Legal Business Name | BEHAVIOR HEALTH & WELLNESS CENTER, LLC
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Dates
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Enumeration Date | 09/29/2009
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 11824 FISHING POINT DR STE B
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-2679
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Country | US
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Telephone | 757-599-0012
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Fax | 888-519-4656
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Provider Business Mailing Address
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Address Line | 3024 CONE MANOR LN
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City | RALEIGH
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State | NC
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Zip | 27613-6604
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Country | US
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Telephone | 510-776-3984
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MR. MARLIN ADILI METTERS
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Credential |
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Telephone | 510-776-3984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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