Provider Demographics
NPI:1669857843
Name:ASHBY GAP PSYCHIATRIC CENTER
Entity Type:Organization
Organization Name:ASHBY GAP PSYCHIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DE VILLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LPC
Authorized Official - Phone:843-209-2067
Mailing Address - Street 1:PO BOX 915
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20118
Mailing Address - Country:US
Mailing Address - Phone:540-326-4536
Mailing Address - Fax:
Practice Address - Street 1:119 THE PLAINS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MIDDLEBURG
Practice Address - State:VA
Practice Address - Zip Code:20117
Practice Address - Country:US
Practice Address - Phone:540-326-4536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA701004712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty