Provider Demographics
NPI:1245754480
Name:ABOVE AND BEYOND MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ABOVE AND BEYOND MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GWYNN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-288-6905
Mailing Address - Street 1:342 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4420
Mailing Address - Country:US
Mailing Address - Phone:954-288-6905
Mailing Address - Fax:
Practice Address - Street 1:342 CHURCH ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4420
Practice Address - Country:US
Practice Address - Phone:954-288-6905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS6808093261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)