Provider Demographics
NPI:1336914191
Name:JOURNEY HOUSE BEHAVIORAL HEALTH RVA
Entity type:Organization
Organization Name:JOURNEY HOUSE BEHAVIORAL HEALTH RVA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAELER
Authorized Official - Middle Name:BRAINE
Authorized Official - Last Name:MCCOLLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MA, CSAC-S
Authorized Official - Phone:804-201-8060
Mailing Address - Street 1:12386 RIVER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VA
Mailing Address - Zip Code:23192-3048
Mailing Address - Country:US
Mailing Address - Phone:804-201-8060
Mailing Address - Fax:
Practice Address - Street 1:7740 SHRADER RD STE F
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2500
Practice Address - Country:US
Practice Address - Phone:804-201-8060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health