Provider Demographics
NPI: | 1033724216 |
---|---|
Name: | PATRICK HENRY FAMILY SERVICES OPERATIONS |
Entity Type: | Organization |
Organization Name: | PATRICK HENRY FAMILY SERVICES OPERATIONS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | SANDRA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LEWANDOWSKI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 434-376-2006 |
Mailing Address - Street 1: | 1621 ENTERPRISE DR |
Mailing Address - Street 2: | |
Mailing Address - City: | LYNCHBURG |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 24502-5797 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 434-376-2006 |
Mailing Address - Fax: | 434-239-4955 |
Practice Address - Street 1: | 1621 ENTERPRISE DR |
Practice Address - Street 2: | |
Practice Address - City: | LYNCHBURG |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24502-5797 |
Practice Address - Country: | US |
Practice Address - Phone: | 434-376-2006 |
Practice Address - Fax: | 434-239-4955 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-09-14 |
Last Update Date: | 2020-09-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |