Healthcare Provider Details

I. General information

NPI: 1407351752
Provider Name (Legal Business Name): CENTRAL VIRGINIA PSYCHOLGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 PETER JEFFERSON PKWY STE 130
CHARLOTTESVILLE VA
22911-8618
US

IV. Provider business mailing address

5556 HOLMAN DR
GLEN ALLEN VA
23059-2556
US

V. Phone/Fax

Practice location:
  • Phone: 434-218-2424
  • Fax:
Mailing address:
  • Phone: 434-218-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0810005227
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0810005227
License Number StateVA

VIII. Authorized Official

Name: MEGAN SCHAD
Title or Position: OWNER
Credential: PH.D.
Phone: 434-218-2424