Provider Demographics
NPI:1831787035
Name:EMINENT BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:EMINENT BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRIEL
Authorized Official - Middle Name:MOET-JONES
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:CSAC, QPPMH
Authorized Official - Phone:804-617-3225
Mailing Address - Street 1:7631 HULL STREET RD STE 300
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6431
Mailing Address - Country:US
Mailing Address - Phone:804-447-4145
Mailing Address - Fax:
Practice Address - Street 1:7631 HULL STREET RD STE 300
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-6431
Practice Address - Country:US
Practice Address - Phone:804-447-4145
Practice Address - Fax:804-918-2564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty