Organization
LONGEVITY MENTAL HEALTH GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY TYLER (CEO)
(804) 800-2500
Entity
Organization
Contact information
Practice address
4611 DOGWOOD SPRINGS LN APT 104, GLEN ALLEN, VA 23059-7639
(757) 610-8000
Mailing address
4611 DOGWOOD SPRINGS LN APT 104, GLEN ALLEN, VA 23059-7639
(804) 800-2500
(804) 800-2600
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
04/02/2024
Last updated
04/19/2025
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