Provider Demographics
NPI:1073750030
Name:CENTRA HEALTH, INC. COMMUNITY BASED MENTAL HEALTH PROGRAMS
Entity Type:Organization
Organization Name:CENTRA HEALTH, INC. COMMUNITY BASED MENTAL HEALTH PROGRAMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-525-8447
Mailing Address - Street 1:3300 RIVERMONT AVE
Mailing Address - Street 2:COMMUNITY BASED MENTAL HEALTH PROGRAMS-CARLA WARNER
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2030
Mailing Address - Country:US
Mailing Address - Phone:540-525-8447
Mailing Address - Fax:540-342-5395
Practice Address - Street 1:3418 ORANGE AVE NE
Practice Address - Street 2:COMMUNITY BASED MENTAL HEALTH PROGRAMS-CARLA WARNER
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6451
Practice Address - Country:US
Practice Address - Phone:540-525-8447
Practice Address - Fax:540-342-5395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRA HEALTH., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health