Provider Demographics
NPI: | 1952944522 |
---|---|
Name: | RIVERBEND INTEGRATIVE TRAUMA TREATMENT |
Entity Type: | Organization |
Organization Name: | RIVERBEND INTEGRATIVE TRAUMA TREATMENT |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KRISTIANN |
Authorized Official - Middle Name: | NOEL |
Authorized Official - Last Name: | SANTAMARIA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LCSW |
Authorized Official - Phone: | 434-249-1304 |
Mailing Address - Street 1: | 1120 SNOWDEN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | CHARLOTTESVILLE |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22901-1297 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 434-249-1304 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 172 S PANTOPS DR STE C |
Practice Address - Street 2: | |
Practice Address - City: | CHARLOTTESVILLE |
Practice Address - State: | VA |
Practice Address - Zip Code: | 22911-8672 |
Practice Address - Country: | US |
Practice Address - Phone: | 434-961-2555 |
Practice Address - Fax: | 434-961-2556 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2019-10-25 |
Last Update Date: | 2019-10-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Single Specialty |