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Organization
VIRGINIA MEDICAL & THERAPEUTIC SERVICES
Active
Organization
VIRGINIA MEDICAL & THERAPEUTIC SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN EALY RBT, M.ED (CHIEF MANAGEMENT OFFICER)
(804) 550-6733
Entity
Organization
Contact information
Practice address
13540 E BOUNDARY RD, MIDLOTHIAN, VA 23112
(804) 550-6733
Mailing address
13540 E BOUNDARY RD, MIDLOTHIAN, VA 23112-3943
(804) 550-6733
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
VA
101YP2500X
Professional Counselor
0701006356
VA
1041C0700X
Clinical Social Worker
Primary
0904009394
VA
106S00000X
Behavior Technician
—
—
163W00000X
Registered Nurse
—
VA
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
—
VA
183700000X
Pharmacy Technician
—
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
VA
Other
Enumeration date
11/24/2017
Last updated
05/18/2018
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