Organization
PROVENANCE SUBSTANCE ABUSE & WELLNESS CENTERS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEVOLIS NEWBURN (OWNER)
(480) 442-9819
Entity
Organization
Contact information
Practice address
4870 SADLER RD PMB #8903, SUITE 300, GLEN ALLEN, VA 23060
(480) 442-9819
Mailing address
4870 SADLER RD PMB #8903, SUITE 300, GLEN ALLEN, VA 23060
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
Other
Enumeration date
02/07/2023
Last updated
08/20/2024
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