Organization
SOUTHSIDE BEHAVIORAL HEALTH
Active
Organization
SOUTHSIDE BEHAVIORAL HEALTH
Active
Other names
Southside Community Services Board
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH C ENGELHORN LPC (EXECUTIVE DIRECTOR)
(434) 572-6916
Entity
Organization
Contact information
Practice address
143 INDUSTRIAL PARKWAY, CLARKSVILLE, VA 23927
(434) 572-6916
(434) 374-3321
Mailing address
PO BOX 1478, 143 INDUSTRIAL PARKWAY, CLARKSVILLE, VA 23927
(434) 572-6916
(434) 374-3321
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
090
VA
1041C0700X
Clinical Social Worker
090
VA
2084P0800X
Psychiatry Physician
090
VA
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004945514
—
VA
05
—
1700890761
—
VA
05
—
1912252958
—
VA
01
—
CC3355
MEDICARE RAILROAD
VA
Enumeration date
07/27/2006
Last updated
03/09/2021
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