Provider Demographics
NPI:1790446961
Name:RICHMOND AREA CLINICAL SERVICES
Entity Type:Organization
Organization Name:RICHMOND AREA CLINICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHAVEN-ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC,LSATP
Authorized Official - Phone:804-245-6372
Mailing Address - Street 1:11618 LONTOWN MEWS
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-245-6372
Mailing Address - Fax:
Practice Address - Street 1:1025 BOULDERS PKWY STE 410
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-5549
Practice Address - Country:US
Practice Address - Phone:804-988-3210
Practice Address - Fax:804-843-8016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154547388Medicaid