NPIMap

Organization Active NPI

Memorial-Child-Guidance-Clinic

  • Mental Health Counselor
  • Richmond, VA
National Provider Identifier
1699868448
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
065 Issued in VA
Legal business name
MEMORIAL-CHILD-GUIDANCE-CLINIC
Practice address
200 North 22ND Street
N/a
Richmond, VA 23223
Phone
(804) 644-9590
Fax
(804) 649-2151
NPI assigned
Oct 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mark N/a Heirholzer, N/A
Title
Executive Director
Phone
(804) 644-0590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193400000X SINGLE SPECIALTY GROUP 101YM0800X 065 VA Primary

Addresses

Primary practice location

200 North 22ND Street
N/a
Richmond, VA 23223

Mailing address

200 North 22ND Street
N/a
Richmond, VA 23223
Phone (804) 644-9590

Other identifiers 1

IdentifierTypeStateIssuer
4945182MedicaidVA

Other names 1

  • Childsavers of Richmond Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Childsavers2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

200 N 22nd St
Richmond, VA 23223
Phone (804) 644-9590

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699868448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NORTH 22ND STREET",
            "address_2": "N/A",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23223",
            "telephone_number": "804-644-9590",
            "fax_number": "804-649-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NORTH 22ND STREET",
            "address_2": "N/A",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23223",
            "telephone_number": "804-644-9590",
            "fax_number": "804-649-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL-CHILD-GUIDANCE-CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEIRHOLZER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "N/A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "804-644-0590",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "N/A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Mental Health",
            "state": "VA",
            "license": "065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4945182",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Childsavers of Richmond",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.