Provider Demographics
NPI:1629421946
Name:CENTRAL VIRGINIA BEHAVIORAL HEALTH LLC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA BEHAVIORAL HEALTH LLC
Other - Org Name:CENTRAL VIRGINIA BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:MRS
Authorized Official - First Name:C
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SIMMONS-JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:804-263-6403
Mailing Address - Street 1:1213 N 24TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5232
Mailing Address - Country:US
Mailing Address - Phone:804-263-6403
Mailing Address - Fax:
Practice Address - Street 1:1213 N 24TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5232
Practice Address - Country:US
Practice Address - Phone:804-263-6403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA001731101YM0800X, 101YP2500X, 104100000X, 1041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty