Provider Demographics
NPI:1407082811
Name:MENTAL HEALTH COMMUNITY BASED RESOURCES
Entity Type:Organization
Organization Name:MENTAL HEALTH COMMUNITY BASED RESOURCES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LSATP
Authorized Official - Phone:434-542-5448
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23923-0067
Mailing Address - Country:US
Mailing Address - Phone:434-542-5448
Mailing Address - Fax:434-542-5448
Practice Address - Street 1:515 GEORGE WASHINGTON HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923
Practice Address - Country:US
Practice Address - Phone:434-542-5448
Practice Address - Fax:434-542-5448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1304251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health