Organization
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC
Active
Other names
Bon Secours Behavioral Health Group at Memorial Regional
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN QUIRICONI (CFO)
(804) 281-8301
Entity
Organization
Contact information
Practice address
8220 MEADOWBRIDGE RD STE 313, MECHANICSVILLE, VA 23116-2340
(804) 325-8882
(804) 764-3280
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(804) 627-5462
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06115
GROUP PTAN
VA
Enumeration date
11/06/2012
Last updated
07/10/2019
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