Healthcare Provider Details

I. General information

NPI: 1124964838
Provider Name (Legal Business Name): PSYCHMED PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 NEW DESIGN RD
DENDRON VA
23839-2400
US

IV. Provider business mailing address

1209 NEW DESIGN RD
DENDRON VA
23839-2400
US

V. Phone/Fax

Practice location:
  • Phone: 804-396-3229
  • Fax:
Mailing address:
  • Phone: 804-396-3229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: REGES ALEXANDRA HANSEN
Title or Position: MEMBER
Credential: DO
Phone: 804-396-3229