Healthcare Provider Details

I. General information

NPI: 1306653662
Provider Name (Legal Business Name): ALEXANDRA GRACE ARTHUR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12300 WASHINGTON HWY
ASHLAND VA
23005-7646
US

IV. Provider business mailing address

7400 NOBLE AVE
RICHMOND VA
23227-1865
US

V. Phone/Fax

Practice location:
  • Phone: 804-365-4222
  • Fax: 804-365-4261
Mailing address:
  • Phone: 804-519-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904017708
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: