Individual
BARRY 0 TRAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC-A,QMHP-A, RPS
Contact information
Practice address
7405 FIDDLERS LN, GLOUCESTER, VA 23061-4390
(804) 436-4470
Mailing address
7405 FIDDLERS LN, GLOUCESTER, VA 23061-4390
(804) 436-4470
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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