| Department Of Behavioral Healthcare Services | |
|
1811 King Street Portsmouth VA 23704-3032 | |
| (757) 393-5404 | |
| (757) 393-5405 |
| Full Name | Department Of Behavioral Healthcare Services |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1811 King Street, Portsmouth, Virginia |
| Authorized Official Name and Position | Mildred Elaine Breathwaite (DIRECTOR/PROGRAM SPONSOR) |
| Authorized Official Contact | 7573938618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Department Of Behavioral Healthcare Services 1811 King Street Portsmouth VA 23704-3032 Ph: (757) 393-5404 | Department Of Behavioral Healthcare Services 1811 King Street Portsmouth VA 23704-3032 Ph: (757) 393-5404 |
| NPI Number | 1093891699 |
|---|---|
| Provider Enumeration Date | 10/27/2006 |
| Last Update Date | 03/06/2020 |
| Certification Date | 03/06/2020 |
| Medicare PECOS PAC ID | 9032173877 |
|---|---|
| Medicare Enrollment ID | O20041112000176 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093891699 | NPI | - | NPPES |
| 004945204 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 046 (Virginia) | Primary |
| Provider Name | Carey Savage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1528264983 PECOS PAC ID: 6507019791 Enrollment ID: I20130122000367 |
| Provider Name | Sara K Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295834513 PECOS PAC ID: 9335366996 Enrollment ID: I20140806000452 |
| Provider Name | Trimaine Brinkley |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1871721464 PECOS PAC ID: 9032353651 Enrollment ID: I20141208001516 |
| Provider Name | William G Mcglothlin |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1174791859 PECOS PAC ID: 7416237136 Enrollment ID: I20161214001808 |
| Provider Name | Kevin W Johnson |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104212562 PECOS PAC ID: 7719256601 Enrollment ID: I20200625002722 |
| Provider Name | Brittany Zharnest |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417603705 PECOS PAC ID: 8426423419 Enrollment ID: I20230404002864 |
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