Provider Demographics
NPI:1184801466
Name:CNC CLINICAL SERVICES DIRECT
Entity type:Organization
Organization Name:CNC CLINICAL SERVICES DIRECT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BURNETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-743-2922
Mailing Address - Street 1:3724 COTTRELL RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23234-2934
Mailing Address - Country:US
Mailing Address - Phone:804-743-2922
Mailing Address - Fax:
Practice Address - Street 1:3724 COTTRELL RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23234-2934
Practice Address - Country:US
Practice Address - Phone:804-743-2922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty