Organization
CVSS MENTAL HEALTH SUPPORT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DERWIN HICKMAN (CHIEF EXECUTIVE DIRECTOR)
(804) 328-1979
Entity
Organization
Contact information
Practice address
4220 OAKLEYS CT, SUITE B, RICHMOND, VA 23223-5970
(804) 328-1790
(804) 328-1793
Mailing address
5812 NORTHFORD PL, CHESTERFIELD, VA 23832-7590
(804) 328-1790
(804) 328-1793
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
792-03-011
VA
Other
Enumeration date
01/14/2011
Last updated
01/14/2011
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