Provider Demographics
NPI:1821239120
Name:CLINICAL SERVICES OF VIRGINIA, LLC
Entity Type:Organization
Organization Name:CLINICAL SERVICES OF VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:BURNETTE
Authorized Official - Middle Name:SEWARD
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-562-3317
Mailing Address - Street 1:7206 HULL STREET RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5827
Mailing Address - Country:US
Mailing Address - Phone:804-562-3317
Mailing Address - Fax:804-562-0561
Practice Address - Street 1:7206 HULL STREET RD
Practice Address - Street 2:SUITE 202
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-5827
Practice Address - Country:US
Practice Address - Phone:804-562-3317
Practice Address - Fax:804-562-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1257251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1257Medicaid