Provider Demographics
NPI:1760551873
Name:MIRACLES BEHAVIORAL HEALTH CENTER
Entity Type:Organization
Organization Name:MIRACLES BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARAL
Authorized Official - Middle Name:JAMAL
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-400-6974
Mailing Address - Street 1:1108 EAST MAIN STREET
Mailing Address - Street 2:STE. 803
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219
Mailing Address - Country:US
Mailing Address - Phone:804-343-2723
Mailing Address - Fax:
Practice Address - Street 1:66 BRIANDWOOD DR.
Practice Address - Street 2:SUITE A
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265
Practice Address - Country:US
Practice Address - Phone:678-438-1255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA822251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health