Healthcare Provider Details

I. General information

NPI: 1548119779
Provider Name (Legal Business Name): EKATERINA MIKHAILOVNA BELOUS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
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

3812 FACULTY DR
LYNCHBURG VA
24501-3108
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009498
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: