Provider Demographics
NPI:1265924856
Name:BLACKSTONE COUNSELING & BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:BLACKSTONE COUNSELING & BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:434-264-3209
Mailing Address - Street 1:PO BOX 360
Mailing Address - Street 2:
Mailing Address - City:BLACKSTONE
Mailing Address - State:VA
Mailing Address - Zip Code:23824-0360
Mailing Address - Country:US
Mailing Address - Phone:434-264-3209
Mailing Address - Fax:434-264-3224
Practice Address - Street 1:116 W BROAD ST
Practice Address - Street 2:
Practice Address - City:BLACKSTONE
Practice Address - State:VA
Practice Address - Zip Code:23824-1710
Practice Address - Country:US
Practice Address - Phone:434-264-3209
Practice Address - Fax:434-264-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)