Provider Demographics
NPI:1417204512
Name:BEHAVIORAL HEALTH CONSULTANTS OF HAMPTON ROADS LLC
Entity Type:Organization
Organization Name:BEHAVIORAL HEALTH CONSULTANTS OF HAMPTON ROADS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAWNDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:UMBRAGE
Authorized Official - Suffix:
Authorized Official - Credentials:LEMHP
Authorized Official - Phone:757-218-5974
Mailing Address - Street 1:5109 GOLDSBORO DR
Mailing Address - Street 2:3B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23605-1301
Mailing Address - Country:US
Mailing Address - Phone:757-218-5974
Mailing Address - Fax:
Practice Address - Street 1:5109 GOLDSBORO DR
Practice Address - Street 2:3B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23605-1301
Practice Address - Country:US
Practice Address - Phone:757-218-5974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization