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13911 St Francis Blvd Suite 106 Midlothian VA 23114 | |
| (804) 365-8555 | |
| (804) 365-8575 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 13911 St Francis Blvd, Midlothian, Virginia |
| Authorized Official Name and Position | Bruce Sanford Evans (OWNER) |
| Authorized Official Contact | 8043658555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
13911 St Francis Blvd Suite 106 Midlothian VA 23114 Ph: (804) 365-8555 | 13911 St Francis Blvd Suite 106 Midlothian VA 23114 Ph: (804) 365-8555 |
| NPI Number | 1497760193 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 11/26/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497760193 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 0717000980 (Virginia) | Secondary |
| 251S00000X | Community/behavioral Health | 72405001 (Virginia) | Primary |
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