| Blackstone Counseling & Behavioral Health, Llc | |
|
116 W Broad St Blackstone VA 23824-1710 | |
| (434) 264-3209 | |
| (434) 264-3224 |
| Full Name | Blackstone Counseling & Behavioral Health, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 116 W Broad St, Blackstone, Virginia |
| Authorized Official Name and Position | David Fisher (OFFICE MANAGER) |
| Authorized Official Contact | 4342643209 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blackstone Counseling & Behavioral Health, Llc Po Box 360 Blackstone VA 23824-0360 Ph: (434) 264-3209 | Blackstone Counseling & Behavioral Health, Llc 116 W Broad St Blackstone VA 23824-1710 Ph: (434) 264-3209 |
| NPI Number | 1265924856 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 04/29/2024 |
| Certification Date | 04/29/2024 |
| Medicare PECOS PAC ID | 9335586619 |
|---|---|
| Medicare Enrollment ID | O20240321003688 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265924856 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Rosa Jeanene Fisher |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144712787 PECOS PAC ID: 0244677524 Enrollment ID: I20240321003787 |
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