PROVENANCE SUBSTANCE ABUSE & WELLNESS CENTERS LLC
NPI 1649976945
Clinic/Center - Mental Health (Including Community Mental Health Center) in Glen Allen, VA
- Organization
- Clinic/Center
- Mental Health (Including Community Menta...
About PROVENANCE SUBSTANCE ABUSE & WELLNESS CENTERS LLC
This page provides the complete NPI Profile along with additional information for Provenance Substance Abuse & Wellness Centers Llc, a provider established in Glen Allen, Virginia operating as a Clinic/center, focusing in mental health (including community mental health center) . The healthcare provider is registered in the NPI registry with number 1649976945 assigned on February 2023. The practitioner's primary taxonomy code is 261QM0801X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The authorized official of this NPI record is Mr. Devolis Newburn (Owner)
- NPI
- 1649976945 Verify this NPI
- Provider Name
- PROVENANCE SUBSTANCE ABUSE & WELLNESS CENTERS LLC
- Entity Type
- Organization
- Location Address
- 4870 SADLER RD PMB #8903 SUITE 300 GLEN ALLEN, VA 23060
- Location Phone
- (480) 442-9819
- Mailing Address
- 4870 SADLER RD PMB #8903 SUITE 300 GLEN ALLEN, VA 23060
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-07-2023
- Last Update Date
- 08-20-2024
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Mental Health (Including Community Mental Health Center)
- Taxonomy Code
- 261QM0801X
- Type
- Ambulatory Health Care Facilities
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center |
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1649976945, enumerated as an "organization" on February 07, 2023.
The provider is located at 4870 SADLER RD PMB #8903 SUITE 300 GLEN ALLEN, VA 23060 and the phone number is (480) 442-9819.
Clinic/Center with taxonomy code 261QM0801X and a focus in Mental Health (Including Community Mental Health Center).
