Organization
CITY OF PORTSMOUTH
Active
Other names
Department of Behavioral Healthcare Services
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MILDRED ELAINE BREATHWAITE M. ED,CSAC,QMHP,QSAP (DIRECTOR/PROGRAM SPONSOR)
(757) 393-8618
Entity
Organization
Contact information
Practice address
1811 KING STREET, PORTSMOUTH, VA 23704-3032
(757) 393-5404
(757) 393-5405
Mailing address
1811 KING STREET, PORTSMOUTH, VA 23704-3032
(757) 393-5404
(757) 393-5405
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
046
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945204
—
VA
Enumeration date
10/27/2006
Last updated
03/06/2020
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