Healthcare Provider Details

I. General information

NPI: 1942375977
Provider Name (Legal Business Name): RANDY A. RHOAD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 02/06/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 INDEPENDENCE PKWY STE 100
CHESAPEAKE VA
23320-5205
US

IV. Provider business mailing address

640 INDEPENDENCE PKWY STE 100
CHESAPEAKE VA
23320-5205
US

V. Phone/Fax

Practice location:
  • Phone: 757-420-0530
  • Fax: 757-420-0488
Mailing address:
  • Phone: 757-420-0530
  • Fax: 757-420-0488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: