Provider Demographics
NPI:1700241429
Name:TRINITY MENTAL HEALTH SERVICE, LLC
Entity type:Organization
Organization Name:TRINITY MENTAL HEALTH SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-986-8383
Mailing Address - Street 1:9100 ARBORETUM PKWY
Mailing Address - Street 2:SUITE 265
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3499
Mailing Address - Country:US
Mailing Address - Phone:804-986-8383
Mailing Address - Fax:804-272-3654
Practice Address - Street 1:9100 ARBORETUM PKWY
Practice Address - Street 2:SUITE 265
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3499
Practice Address - Country:US
Practice Address - Phone:804-986-8383
Practice Address - Fax:804-272-3654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010555192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAF70698Medicare UPIN