Provider Demographics
NPI:1669410064
Name:DANVILLE PITTSYLVANIA COMMUNITY SERVICES
Entity type:Organization
Organization Name:DANVILLE PITTSYLVANIA COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MENTAL HEALTH
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:BEBEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-793-4931
Mailing Address - Street 1:425 HAIRSTON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-4133
Mailing Address - Country:US
Mailing Address - Phone:434-793-4931
Mailing Address - Fax:434-799-3100
Practice Address - Street 1:425 HAIRSTON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24540-4133
Practice Address - Country:US
Practice Address - Phone:434-793-4931
Practice Address - Fax:434-799-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00195293OtherRAILROAD MEDICARE
VA010135419Medicaid
VA175108OtherBLUE CROSS BLUE SHIELD VA