Provider Demographics
NPI:1962736595
Name:BEHAVIOR HEALTH & WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:BEHAVIOR HEALTH & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARLIN
Authorized Official - Middle Name:ADILI
Authorized Official - Last Name:METTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-776-3984
Mailing Address - Street 1:3024 CONE MANOR LN
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-6604
Mailing Address - Country:US
Mailing Address - Phone:510-776-3984
Mailing Address - Fax:
Practice Address - Street 1:11824 FISHING POINT DR STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2679
Practice Address - Country:US
Practice Address - Phone:757-599-0012
Practice Address - Fax:888-519-4656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No2080P0006XAllopathic & Osteopathic PhysiciansPediatricsDevelopmental - Behavioral PediatricsGroup - Multi-Specialty