| |
13354 Midlothian Tpke Ste 200 Midlothian VA 23113-4258 | |
(804) 277-9355 | |
Not Available |
Full Name | |
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Speciality | Counselor |
Location | 13354 Midlothian Tpke Ste 200, Midlothian, Virginia |
Authorized Official Name and Position | Danielle Johnson (OWNER) |
Authorized Official Contact | 8042779355 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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13354 Midlothian Tpke Ste 200 Midlothian VA 23113-4258 Ph: (804) 277-9355 | 13354 Midlothian Tpke Ste 200 Midlothian VA 23113-4258 Ph: (804) 277-9355 |
NPI Number | 1710496880 |
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Provider Enumeration Date | 09/21/2017 |
Last Update Date | 10/30/2020 |
Certification Date | 10/30/2020 |
Medicare PECOS PAC ID | 6608309331 |
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Medicare Enrollment ID | O20241101001681 |
Identifier | Type | State | Issuer |
---|---|---|---|
1710496880 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
101YP2500X | Counselor - Professional | 0701005893 (Virginia) | Primary |
Provider Name | Danielle Johnson |
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Provider Type | Practitioner - Mental Health Counselor |
Provider Identifiers | NPI Number: 1669875084 PECOS PAC ID: 7416480140 Enrollment ID: I20241101001912 |
Commonwealth Behavioral Health, Inc. Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 13356 Midlothian Tpke, Suite 202, Midlothian, VA 23113 Phone: 804-721-1720 Fax: 804-214-2177 | |
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