Organization
DISTRICT 19 COMMUNITY SERVICES BOARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TERESA WULF-HELLER LCSW (CLINICAL SERVICES DIRECTOR)
(804) 862-8002
Entity
Organization
Contact information
Practice address
5012 SELWOOD RD, RICHMOND, VA 23234-4246
(804) 862-8002
(804) 862-8060
Mailing address
5012 SELWOOD RD, RICHMOND, VA 23234-4246
(804) 275-6161
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
0904002353
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
086373
SENTARA
VA
01
—
270506
ANTHEM
VA
05
—
4945280
—
VA
01
—
R62892
INACTIVE
VA
Enumeration date
06/01/2006
Last updated
09/15/2008
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