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Harrisonburg, Virginia

Provider NPI: 1558369728

Provider Information:
Gender: M

Practice Location:
Tel: 540-433-3100  Fax: 540-432-6989

Business Mailing Address:
Tel: 540-433-3100  Fax: 540-432-6989

Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
X101Y00000XBehavioral Health & Social Service Providers
X101YM0800XBehavioral Health & Social Service Providers
X101YP2500XBehavioral Health & Social Service Providers

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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