Healthcare Provider Details

I. General information

NPI: 1972591071
Provider Name (Legal Business Name): TIMOTHY H. BARCLAY PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1047 VISTA PARK DR STE A
FOREST VA
24551-4362
US

IV. Provider business mailing address

1047 VISTA PARK DR. STE A
FOREST VA
24551-2283
US

V. Phone/Fax

Practice location:
  • Phone: 434-616-2388
  • Fax:
Mailing address:
  • Phone: 434-616-2388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810004569
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: