Healthcare Provider Details

I. General information

NPI: 1588456255
Provider Name (Legal Business Name): EMILY ANNE WARREN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2025
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST BOX #800223
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 434-924-5314
  • Fax: 434-243-4743
Mailing address:
  • Phone:
  • Fax: 434-243-4743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009240
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: