Provider Demographics
NPI:1073161956
Name:BEHAVIORAL HEALTH ASSOCIATES OF VIRGINIA
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH ASSOCIATES OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-721-7528
Mailing Address - Street 1:4196 MERCHANT PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5085
Mailing Address - Country:US
Mailing Address - Phone:804-721-7528
Mailing Address - Fax:
Practice Address - Street 1:11030 WARWICK BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3251
Practice Address - Country:US
Practice Address - Phone:757-534-9088
Practice Address - Fax:757-534-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-03
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty