Provider Demographics
NPI:1922326909
Name:MIDLOTHIAN BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:MIDLOTHIAN BEHAVIORAL HEALTH ASSOCIATES, LLC
Other - Org Name:MBHA
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-897-9355
Mailing Address - Street 1:14410 SOMMERVILLE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6835
Mailing Address - Country:US
Mailing Address - Phone:804-897-9355
Mailing Address - Fax:804-897-9359
Practice Address - Street 1:14410 SOMMERVILLE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6835
Practice Address - Country:US
Practice Address - Phone:804-897-9355
Practice Address - Fax:804-897-9359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health