MEDICARE: DOMINION BEHAVIORAL HEALTHCARE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YM0800X	Mental Health Counselor	VA
2	1041C0700X	Clinical Social Worker	VA
3	103T00000X	Psychologist	VA

General Provider Information

NPI Number	:	1841413184
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION BEHAVIORAL HEALTHCARE

Provider Business Mailing Address
First Line	:	11551 NUCKOLS RD
Second Line	:	SUITE F
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5565
Country	:	US
Telephone Number	:	804-364-4400
Fax Number	:	804-364-0120

Provider Business Practice Location Address
First Line	:	11551 NUCKOLS RD
Second Line	:	SUITE F
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-5565
Country	:	US
Telephone Number	:	804-364-4400
Fax Number	:	804-364-0120

Authorized Official
Title or Position	:	OWNER
Name	:	DIANNE Z HENSLEY
Credential	:	LCSW
Telephone Number	:	804-270-1124

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	09/11/2025

Similar Medicare Providers

1255903860 — CAYCEE FROST PA-C
Practice Location Address:

11551 NUCKOLS RD STE C
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23059-5565

Practice Phone: 804-888-6800
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1255424206 — KEITH ANDREW DERCO M.D.
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1194818690 — TAMARA ALBERTI SUTHERLAND M.D.
Practice Location Address:

11551 NUCKOLS RD , SUITE F
GLEN ALLEN, VA
23059-5565

Practice Phone: 804-364-4400
Practice Fax: 804-364-0120

1760529358 — DR. ROBERT LEE CAMPBELL DDS
Practice Location Address:

11551 NUCKOLS RD STE A
GLEN ALLEN, VA
23059-5565

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Practice Fax: 804-273-0359

1851422331 — RENITA WALDEN RANDOLPH D.D.S.
Practice Location Address:

11551 NUCKOLS RD , SUITE A
GLEN ALLEN, VA
23059-5565

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1225155781 — ASSOCIATES IN PEDIATRICS
Practice Location Address:

11551 NUCKOLS RD , SUITE F
GLEN ALLEN, VA
23059-5565

Practice Phone: 808-364-4400
Practice Fax: 804-364-0120

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