Provider Demographics
NPI:1194029884
Name:CAMELOT THERAPEUTIC SCHOOLS, LLC
Entity Type:Organization
Organization Name:CAMELOT THERAPEUTIC SCHOOLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:540-980-1007
Mailing Address - Street 1:800 RIDGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:VA
Mailing Address - Zip Code:24301
Mailing Address - Country:US
Mailing Address - Phone:540-980-1007
Mailing Address - Fax:540-980-0505
Practice Address - Street 1:800 RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:VA
Practice Address - Zip Code:24301-3943
Practice Address - Country:US
Practice Address - Phone:540-980-7001
Practice Address - Fax:540-980-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health