Southside Behavioral Health
Organization Active NPI Community/Behavioral Health Agency · Clarksville, VA
NPI 1700890761 · NPPES record last updated Mar 9, 2021
Key facts
- NPI
- 1700890761
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Behavioral Health Agency 251S00000X
- Legal business name
- SOUTHSIDE BEHAVIORAL HEALTH
- Practice address
- 143 Industrial Parkway
Clarksville, VA 23927 - Phone
- (434) 572-6916
- Fax
- (434) 374-3321
- NPI assigned
- Jul 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Elizabeth C Engelhorn, LPC
- Title
- Executive Director
- Phone
- (434) 572-6916
Corporate family (same tax ID) 2
Practitioners 108
-
Kathrine Elowe Adams, D.O.
-
Mark Winston Anderegg, LCSW
-
Justin Michael Brown, LPC
-
Rosemary Cosselmon, LPC
-
Rita Kay Lynch, LPC
-
Linda Ray Montgomery, LPC
-
Nellie Parrish, LCSW
-
Andrew Thomas Power, M.ED., LPC
-
Paula L Stone, LPC
-
Joe Darnell Trickey Jr., PMHNP
-
Darrin Adams, LPC, RN
-
Sarah Allen, LPC
-
Kenatta Bethea, PMHNP-BC
-
Taylor Breanne Bowen, LPC
-
Sharon M Craft, DNP
-
Samantha Lynn Dean, MSSW, LCSW
-
Brittany Leanna Dolan, MSN-FNP, BC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050708000612 | VA | Part B Supplier - Clinic/Group Practice | 4284660507 |
Receives reassigned benefits from 79 practitioners Practice locations: Boydton, VA; Clarksville, VA; Lawrenceville, VA; South Boston, VA; South Hill, VA |
National Provider Directory
- Tax ID family
- Southside Behavioral Health
Locations
523 Madison St
Boydton, VA 23917
Phone (434) 738-0154
3030 Philpott Rd
South Boston, VA 24592
Phone (434) 572-9563
424 Hamilton Blvd
South Boston, VA 24592
Phone (434) 572-2936
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | 090 | VA | |
| Clinical Social Worker |
1041C0700X | 090 | VA | |
| Psychiatry Physician |
2084P0800X | 090 | VA | |
| Community/Behavioral Health Agency | 251S00000X | Yes |
Addresses
Primary practice location
143 Industrial Parkway
Clarksville, VA 23927
Mailing address
PO Box 1478
143 Industrial Parkway
Clarksville, VA 23927
Phone (434) 572-6916
Other practice location 1
2087 Lawrenceville Plank Road
Lawrenceville, VA 23868
Phone (434) 848-4121
Other practice location 2
523 Madison Street
Boydton, VA 23917
Phone (434) 738-0154
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004945514 | Medicaid | VA | |
| 1912252958 | Medicaid | VA | |
| 1700890761 | Medicaid | VA | |
| CC3355 | Other | VA | MEDICARE RAILROAD |
Other names
- Southside Community Services Board
Other providers in Clarksville, VA
- Andrew Thomas Power
- Diane Rodil
- Kayla Royster
- Jessica Driggs Ruff
- Alicia Devon Small
- Intekhab Askari Syed Ahmad Raza
- Chelsey Marie Tanner
- Ashley Mae Terry
- Colton Ryan Thames
- Victoria Tyler
All providers in Clarksville, VA · Community/Behavioral Health Agency in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.