Provider Demographics
NPI:1750088274
Name:THE MILIEU THERAPEUTIC SERVICES, ,PC
Entity type:Organization
Organization Name:THE MILIEU THERAPEUTIC SERVICES, ,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:VAUGHN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:833-464-5438
Mailing Address - Street 1:5007C VICTORY BLVD # 118
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23693-5601
Mailing Address - Country:US
Mailing Address - Phone:833-464-5438
Mailing Address - Fax:757-578-8226
Practice Address - Street 1:1730 GEORGE WASHINGTON MEM HWY STE F-6
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23693-4328
Practice Address - Country:US
Practice Address - Phone:833-464-5438
Practice Address - Fax:757-578-8226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MILIEU THERAPEUTIC SERVICES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No171000000XOther Service ProvidersMilitary Health Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5253-07-006OtherDBHDS PROVIDER LICENSE
VA30015303970004Medicaid