Provider Demographics
NPI:1932290624
Name:FAMILY BEHAVIORAL HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:FAMILY BEHAVIORAL HEALTH ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:T
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-744-9652
Mailing Address - Street 1:5001 W VILLAGE GREEN DR
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4801
Mailing Address - Country:US
Mailing Address - Phone:804-744-9652
Mailing Address - Fax:804-744-1265
Practice Address - Street 1:5001 W VILLAGE GREEN DR
Practice Address - Street 2:SUITE 211
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4801
Practice Address - Country:US
Practice Address - Phone:804-744-9652
Practice Address - Fax:804-744-1265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000953103TC0700X
VA0015000796363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty