MEDICARE: DISTRICT 19 COMMUNITY SERVICES BOARD

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	251K00000X	Public Health or Welfare Agency	0904002353	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	270506	OTHER	VA	ANTHEM
2	R62892	OTHER	VA	INACTIVE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	086373	OTHER	VA	SENTARA

General Provider Information

NPI Number	:	1679510226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTRICT 19 COMMUNITY SERVICES BOARD

Provider Business Mailing Address
First Line	:	5012 SELWOOD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-4246
Country	:	US
Telephone Number	:	804-275-6161
Fax Number	:

Provider Business Practice Location Address
First Line	:	5012 SELWOOD RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23234-4246
Country	:	US
Telephone Number	:	804-862-8002
Fax Number	:	804-862-8060

Authorized Official
Title or Position	:	CLINICAL SERVICES DIRECTOR
Name	:	MS. TERESA WULF-HELLER
Credential	:	LCSW
Telephone Number	:	804-862-8002

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	09/15/2008

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Directions to “DISTRICT 19 COMMUNITY SERVICES BOARD ” Practice Location

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