Healthcare Provider Details

I. General information

NPI: 1548643356
Provider Name (Legal Business Name): CRYSTAL J CORDES PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 COURTHOUSE RD STE 206
CHESTERFIELD VA
23832-6690
US

IV. Provider business mailing address

9401 COURTHOUSE RD STE 206
CHESTERFIELD VA
23832-6690
US

V. Phone/Fax

Practice location:
  • Phone: 804-751-8644
  • Fax:
Mailing address:
  • Phone: 804-751-8644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20043653B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: