Provider Demographics
NPI:1063545176
Name:SOUTHAMPTON BEHAVIORAL HEALTHCARE, LLC
Entity type:Organization
Organization Name:SOUTHAMPTON BEHAVIORAL HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:G
Authorized Official - Last Name:REED,
Authorized Official - Suffix:JR
Authorized Official - Credentials:LPC
Authorized Official - Phone:757-569-0007
Mailing Address - Street 1:PO BOX 633
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-0633
Mailing Address - Country:US
Mailing Address - Phone:757-569-0007
Mailing Address - Fax:757-569-0011
Practice Address - Street 1:100 FAIRVIEW DR
Practice Address - Street 2:BLDG. 2, SUITE 200-B
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-1238
Practice Address - Country:US
Practice Address - Phone:757-569-0007
Practice Address - Fax:757-569-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003254101YM0800X
NC3450101YM0800X
VA01010500052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA548467OtherVALUEOPTIONS
VA069022OtherVALUEOPTIONS
VA186340OtherANTHEM BCBS
VAO86305MOtherSBHS
VA186337OtherANTHEM BCBS
VA368995OtherMHN
VA069022OtherVALUEOPTIONS
VA548467OtherVALUEOPTIONS