Provider Demographics
NPI:1518118629
Name:VIRGINIA BEACH METHADONE CLINIC
Entity Type:Organization
Organization Name:VIRGINIA BEACH METHADONE CLINIC
Other - Org Name:VBMC
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, LCAS, CCS
Authorized Official - Phone:757-437-0411
Mailing Address - Street 1:1728 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-4533
Mailing Address - Country:US
Mailing Address - Phone:757-437-0411
Mailing Address - Fax:757-437-5846
Practice Address - Street 1:1728 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-4533
Practice Address - Country:US
Practice Address - Phone:757-437-0411
Practice Address - Fax:757-437-5846
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELLATI & CO., INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA089251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health