Provider Demographics
NPI:1861670549
Name:CSB - LOUDOUN MENTAL HEALTH
Entity Type:Organization
Organization Name:CSB - LOUDOUN MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST - INTERN
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:703-727-9143
Mailing Address - Street 1:41923 BERYL TER
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2906
Mailing Address - Country:US
Mailing Address - Phone:703-727-9143
Mailing Address - Fax:
Practice Address - Street 1:41923 BERYL TER
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-2906
Practice Address - Country:US
Practice Address - Phone:703-727-9143
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health