Provider Demographics
NPI:1194394981
Name:ATLANTIC BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ATLANTIC BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZZANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-621-7121
Mailing Address - Street 1:199 LIBERTY ST SW
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-2715
Mailing Address - Country:US
Mailing Address - Phone:703-621-7121
Mailing Address - Fax:
Practice Address - Street 1:199 LIBERTY ST SW
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-2715
Practice Address - Country:US
Practice Address - Phone:703-621-7121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC COUNSELING GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty