Provider Demographics
NPI:1275388613
Name:TRAVIS, BARRY 0 (CSAC-A,QMHP-A, RPS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:0
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:CSAC-A,QMHP-A, RPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7405 FIDDLERS LN
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23061-4390
Mailing Address - Country:US
Mailing Address - Phone:804-436-4470
Mailing Address - Fax:
Practice Address - Street 1:7405 FIDDLERS LN
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:VA
Practice Address - Zip Code:23061-4390
Practice Address - Country:US
Practice Address - Phone:804-436-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)