| Civitas Health Services, Inc. | |
|
5663 S Laburnum Ave Richmond VA 23231-4418 | |
| (804) 737-3917 | |
| (804) 737-3940 |
| Full Name | Civitas Health Services, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5663 S Laburnum Ave, Richmond, Virginia |
| Authorized Official Name and Position | Lemar Bowers (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8047373917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Civitas Health Services, Inc. 5663 S Laburnum Ave Richmond VA 23231-4418 Ph: (804) 737-3917 | Civitas Health Services, Inc. 5663 S Laburnum Ave Richmond VA 23231-4418 Ph: (804) 737-3917 |
| NPI Number | 1366727984 |
|---|---|
| Provider Enumeration Date | 10/14/2011 |
| Last Update Date | 07/21/2016 |
| Medicare PECOS PAC ID | 2961624994 |
|---|---|
| Medicare Enrollment ID | O20141106002486 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366727984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 1588 (Virginia) | Primary |
| Provider Name | Faith B Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821469172 PECOS PAC ID: 1759677982 Enrollment ID: I20160914000766 |
| Provider Name | Sarah Elizabeth Matalavage |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770091944 PECOS PAC ID: 1254760325 Enrollment ID: I20200413000339 |
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