Healthcare Provider Details

I. General information

NPI: 1447341805
Provider Name (Legal Business Name): VIRGINIA CENTER FOR FAMILY RELATIONS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 SACHEM PLACE SUITE101
CHARLOTTESVILLE VA
22901
US

IV. Provider business mailing address

1450 SACHEM PLACE SUITE101
CHARLOTTESVILLE VA
22901
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-5640
  • Fax:
Mailing address:
  • Phone: 434-973-5640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710000770
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701001071
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701001887
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002541
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701003925
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904003728
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904001603
License Number StateVA
# 9
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000095
License Number StateVA
# 10
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000162
License Number StateVA
# 11
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717000431
License Number StateVA

VIII. Authorized Official

Name: LARRY L. FRENCH
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, LPC, LMFT
Phone: 434-973-5640