Provider Demographics
NPI:1144608142
Name:VIKING BEHAVIORAL SERVICES LLC
Entity Type:Organization
Organization Name:VIKING BEHAVIORAL SERVICES LLC
Other - Org Name:VIKING BEHAVIORAL SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CONSULTATION SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:VIKING
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW,PBSF
Authorized Official - Phone:303-875-5869
Mailing Address - Street 1:PO BOX 3074
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-0918
Mailing Address - Country:US
Mailing Address - Phone:303-875-5869
Mailing Address - Fax:
Practice Address - Street 1:10168 PORTSMOUTH RD
Practice Address - Street 2:APT #6
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-8047
Practice Address - Country:US
Practice Address - Phone:303-875-5869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA15L20280251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health