Provider Demographics
NPI:1053985150
Name:ADOLESCENT BEHAVIOR SERVICES LLC.
Entity type:Organization
Organization Name:ADOLESCENT BEHAVIOR SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:I
Authorized Official - Credentials:MED QMHP-A/C
Authorized Official - Phone:804-335-7457
Mailing Address - Street 1:4036 WEST TER
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8380
Mailing Address - Country:US
Mailing Address - Phone:804-335-7549
Mailing Address - Fax:804-276-5369
Practice Address - Street 1:4036 WEST TER
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8380
Practice Address - Country:US
Practice Address - Phone:804-335-7549
Practice Address - Fax:804-276-5369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health