Organization
MIDDLE PENINSULA NORTHERN NECK MENTAL HEALTH & RETARDATION
Active
Other names
MIDDLE PENINSULA NORTHERN NECK COUNSELING CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. YVONNE M WINGROVE M.ED. (CHIEF FINANCIAL OFFICER)
(804) 693-5640
Entity
Organization
Contact information
Practice address
9228 GEORGE WASHINGTON MEMORIAL HWY, GLOUCESTER, VA 23061-4162
(804) 693-5068
(804) 693-7407
Mailing address
PO BOX 269, ARK, VA 23003-0269
(804) 693-5640
(804) 693-4822
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945115
—
VA
05
—
1497717615
—
VA
01
—
250202
ANTHEM
VA
01
—
250204
ANTHEM
VA
01
—
250208
ANTHEM
VA
01
—
294721
VALUE OPTIONS
VA
Enumeration date
04/04/2006
Last updated
06/21/2018
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