1891892469 NPI number — CENTER FOR COUNSELING AND BEHAVIORAL MEDICINE

Table of content: (NPI 1891892469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891892469 NPI number — CENTER FOR COUNSELING AND BEHAVIORAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COUNSELING AND BEHAVIORAL MEDICINE
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:
Provider Other Organization Name Type Code:
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:
1891892469
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2215
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHESTERFIELD
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23832-9112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-717-5419
Provider Business Mailing Address Fax Number:
804-520-8595

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10106 KRAUSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23832-6572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-717-5419
Provider Business Practice Location Address Fax Number:
804-520-8595
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MEKHOUBAT
Authorized Official First Name:
AARON
Authorized Official Middle Name:
B
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
804-717-5419

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 087856 . This is a "SENTARA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 178550 . This is a "COMPSYCH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7346205 . This is a "AETNA HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2007414 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 323687 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 366110 . This is a "VALUE OPTIONS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 342367 . This is a "MAMSI" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 237206 . This is a "ANTHEM HEALTHKEEPERS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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