MEDICARE: PIEDMONT THERAPEUTIC SERVICES,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1831813096
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT THERAPEUTIC SERVICES,LLC

Provider Business Mailing Address
First Line	:	3215 ROCK CREEK VILLA DR
Second Line	:
City	:	QUINTON
State	:	VA
Zip	:	23141-1656
Country	:	US
Telephone Number	:	804-314-9462
Fax Number	:

Provider Business Practice Location Address
First Line	:	3215 ROCK CREEK VILLA DR
Second Line	:
City	:	QUINTON
State	:	VA
Zip	:	23141-1656
Country	:	US
Telephone Number	:	804-314-9462
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYD
Name	:	DONNA T PURCELL
Credential	:	PSYD
Telephone Number	:	804-314-9462

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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