Provider Demographics
NPI:1477563492
Name:LIFE CONSTRUCTION MENTAL HEALTH SERVICES
Entity Type:Organization
Organization Name:LIFE CONSTRUCTION MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EUNICE
Authorized Official - Middle Name:BASS
Authorized Official - Last Name:GILCHRIST
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MS
Authorized Official - Phone:804-359-3737
Mailing Address - Street 1:3105 W MARSHALL ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4729
Mailing Address - Country:US
Mailing Address - Phone:804-359-3737
Mailing Address - Fax:804-359-2266
Practice Address - Street 1:3105 W MARSHALL ST
Practice Address - Street 2:SUITE 114
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4729
Practice Address - Country:US
Practice Address - Phone:804-359-3737
Practice Address - Fax:804-359-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA721101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010236878Medicaid