| The Milieu Therapeutic Services, Pc | |
|
201 Monticello Mews Hampton VA 23666-2781 | |
| (833) 464-5438 | |
| (757) 578-8226 |
| Full Name | The Milieu Therapeutic Services, Pc |
|---|---|
| Speciality | Counselor |
| Location | 201 Monticello Mews, Hampton, Virginia |
| Authorized Official Name and Position | Willard Allen Vaughn (CEO) |
| Authorized Official Contact | 8334645438 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Milieu Therapeutic Services, Pc 110 Coliseum Xing # 6045 Hampton VA 23666-5971 Ph: (833) 464-5438 | The Milieu Therapeutic Services, Pc 201 Monticello Mews Hampton VA 23666-2781 Ph: (833) 464-5438 |
| NPI Number | 1679068597 |
|---|---|
| Provider Enumeration Date | 06/23/2018 |
| Last Update Date | 07/03/2026 |
| Certification Date | 07/03/2026 |
| Medicare PECOS PAC ID | 2668837147 |
|---|---|
| Medicare Enrollment ID | O20230505001798 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679068597 | NPI | - | NPPES |
| 079317721 | Medicaid | DC | |
| 30050538 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Willard Allen Vaughn |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1760637219 PECOS PAC ID: 2365873510 Enrollment ID: I20240617002813 |
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