Provider Demographics
NPI:1477150068
Name:PREMIER MENTAL HEALTH SUPPORT
Entity Type:Organization
Organization Name:PREMIER MENTAL HEALTH SUPPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:HARPER
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-728-2641
Mailing Address - Street 1:490 PINEY FOREST RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4060
Mailing Address - Country:US
Mailing Address - Phone:434-797-1094
Mailing Address - Fax:434-797-1096
Practice Address - Street 1:490 PINEY FOREST RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4060
Practice Address - Country:US
Practice Address - Phone:434-797-1094
Practice Address - Fax:434-797-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-06
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health