Provider Demographics
NPI:1235461849
Name:TEEN OPTION, INC.
Entity type:Organization
Organization Name:TEEN OPTION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:A. JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAMISILE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:804-745-8070
Mailing Address - Street 1:6432 ELKHARDT RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-7819
Mailing Address - Country:US
Mailing Address - Phone:804-745-8070
Mailing Address - Fax:804-745-7554
Practice Address - Street 1:6432 ELKHARDT RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-7819
Practice Address - Country:US
Practice Address - Phone:804-745-8070
Practice Address - Fax:804-745-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1528-05-001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health