MEDICARE: PROACTIVE BEHAVIORAL SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1003162538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROACTIVE BEHAVIORAL SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 15601
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-5601
Country	:	US
Telephone Number	:	804-864-2366
Fax Number	:	804-864-2366

Provider Business Practice Location Address
First Line	:	3018 W CLAY ST
Second Line	:	SUITE 204
City	:	RICHMOND
State	:	VA
Zip	:	23230-4702
Country	:	US
Telephone Number	:	804-447-4629
Fax Number	:	804-447-4629

Authorized Official
Title or Position	:	OWNER
Name	:	MS. KEISHA WRIGHT
Credential	:
Telephone Number	:	804-864-2366

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	04/07/2026

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