Provider Demographics
NPI:1871676973
Name:ADVANCED BEHAVIORAL SOLUTIONS, P.C.
Entity Type:Organization
Organization Name:ADVANCED BEHAVIORAL SOLUTIONS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-270-7477
Mailing Address - Street 1:4000 WILLIAM CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-7625
Mailing Address - Country:US
Mailing Address - Phone:804-270-7477
Mailing Address - Fax:804-270-7411
Practice Address - Street 1:6809 PATTERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3650
Practice Address - Country:US
Practice Address - Phone:804-270-7477
Practice Address - Fax:804-270-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040014141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8905444Medicaid
VA8905444Medicaid