Provider Demographics
NPI:1427075449
Name:DOMINION BEHAVIORAL HEALTHCARE
Entity type:Organization
Organization Name:DOMINION BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:ZITTO
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-270-1124
Mailing Address - Street 1:2301 N PARHAM RD STE 5
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3171
Mailing Address - Country:US
Mailing Address - Phone:804-270-1124
Mailing Address - Fax:804-270-2090
Practice Address - Street 1:2301 N PARHAM RD STE 5
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-3171
Practice Address - Country:US
Practice Address - Phone:804-270-1124
Practice Address - Fax:804-270-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000405101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty