Healthcare Provider Details

I. General information

NPI: 1093383259
Provider Name (Legal Business Name): ALBEMARLE DYNAMIC PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/15/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 FOUR LEAF LN STE 12
CHARLOTTESVILLE VA
22903-9203
US

IV. Provider business mailing address

PO BOX 28
CROZET VA
22932-0028
US

V. Phone/Fax

Practice location:
  • Phone: 434-466-1588
  • Fax: 866-289-5249
Mailing address:
  • Phone: 434-996-7605
  • Fax: 866-289-5249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN STEPHENS
Title or Position: OWNER
Credential: MD
Phone: 434-996-7605