Provider Demographics
NPI:1538120670
Name:DANVILLE-PITTSYLVANIA COMMUNITY SERVICES
Entity Type:Organization
Organization Name:DANVILLE-PITTSYLVANIA COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-799-0456
Mailing Address - Street 1:245 HAIRSTON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4137
Mailing Address - Country:US
Mailing Address - Phone:434-799-0456
Mailing Address - Fax:434-793-4201
Practice Address - Street 1:245 HAIRSTON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4137
Practice Address - Country:US
Practice Address - Phone:434-799-0456
Practice Address - Fax:434-793-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA085644OtherOPTIMA FAMILY CARE
VA004945085Medicaid
VAO85644OtherOPTIMA FAMILY CARE GROUP
VAC03176Medicare UPIN