Provider Demographics
NPI:1376699249
Name:PALADIN BEHAVIORAL AND FORENSIC SERVICES
Entity type:Organization
Organization Name:PALADIN BEHAVIORAL AND FORENSIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD LCP
Authorized Official - Phone:757-288-9907
Mailing Address - Street 1:PO BOX 13296
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-0296
Mailing Address - Country:US
Mailing Address - Phone:757-714-1838
Mailing Address - Fax:757-321-6269
Practice Address - Street 1:933 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 203
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3172
Practice Address - Country:US
Practice Address - Phone:757-288-9907
Practice Address - Fax:757-321-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08570Medicare PIN