Provider Demographics
NPI:1023119773
Name:HENRICO AREA MENTAL HEATLH AND DEVELOPMENTAL SERVICES
Entity type:Organization
Organization Name:HENRICO AREA MENTAL HEATLH AND DEVELOPMENTAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOTTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-727-8585
Mailing Address - Street 1:10299 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-727-8500
Mailing Address - Fax:804-727-8580
Practice Address - Street 1:10299 WOODMAN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-4419
Practice Address - Country:US
Practice Address - Phone:804-727-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA099261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978544Medicaid
VA110330OtherANTHEM GROUP NUMBER
VA4945131Medicaid
VA153980000OtherMAGELLAN GROUP NUMBER
VA324461OtherVALUE OPTIONS GROUP NUMBE
VA110330OtherANTHEM GROUP NUMBER
VA324461OtherVALUE OPTIONS GROUP NUMBE
VAC08197Medicare ID - Type UnspecifiedGROUP NUMBER
VAC00779Medicare ID - Type UnspecifiedGROUP NUMBER