Provider Demographics
NPI:1659641330
Name:DOMINION BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:DOMINION BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCNEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-294-4779
Mailing Address - Street 1:810 N BRAEBURN PL
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-9008
Mailing Address - Country:US
Mailing Address - Phone:540-280-9081
Mailing Address - Fax:540-886-7380
Practice Address - Street 1:810 N BRAEBURN PL
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-9008
Practice Address - Country:US
Practice Address - Phone:540-280-9081
Practice Address - Fax:540-886-7380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty