Organization
EVERGREEN BEHAVIORAL HEALTH SERVICES,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE CHARLES WYMAN EDM, NCC, LPC (CEO)
(540) 937-4923
Entity
Organization
Contact information
Practice address
10391 GREYSON LN, RIXEYVILLE, VA 22737-1730
(540) 937-4923
(540) 937-7680
Mailing address
PO BOX 373, RIXEYVILLE, VA 22737-0373
(540) 937-4923
(540) 937-7680
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0701003919
VA
101YP2500X
Professional Counselor
Primary
0701003919
VA
101YS0200X
School Counselor
0701003919
VA
106H00000X
Marriage & Family Therapist
0701003919
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01619872
ANTHEM
VA
Enumeration date
04/03/2012
Last updated
05/07/2014
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