1649209990 NPI number — DICKENSON COUNTY BEHAVIORAL HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649209990 NPI number — DICKENSON COUNTY BEHAVIORAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DICKENSON COUNTY BEHAVIORAL HEALTH SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DICKENSON COUNTY COMMUNITY SERVICES BOARD
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649209990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 309
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTWOOD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24228-0309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-926-1682
Provider Business Mailing Address Fax Number:
276-926-8134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
440 FOX TOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTWOOD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24228-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-926-1682
Provider Business Practice Location Address Fax Number:
276-926-9179
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MULLINS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
276-926-1682

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  091-07-004 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X , with the licence number: 091-16-001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X , with the licence number: 091-16-001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 091-01-001 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 542636 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 004945549 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 542631 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 324879 . This is a "TRIGON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 385241 . This is a "TRIGON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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