Provider Demographics
NPI:1689032021
Name:VERITAS COLLABORATIVE VIRGINIA, LLC
Entity type:Organization
Organization Name:VERITAS COLLABORATIVE VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCENTYRE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:919-908-9730
Mailing Address - Street 1:411 ROSENEATH RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-2324
Mailing Address - Country:US
Mailing Address - Phone:407-353-6209
Mailing Address - Fax:
Practice Address - Street 1:6627 W BROAD ST
Practice Address - Street 2:SUITE 400
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1732
Practice Address - Country:US
Practice Address - Phone:804-592-1019
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VERITAS COLLABORATIVE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)