Healthcare Provider Details

I. General information

NPI: 1437688546
Provider Name (Legal Business Name): CENTER FOR PSYCHOLOGICAL ASSESSMENT AND CONSULTATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 PRINCESS ANNE ST STE 102
FREDERICKSBURG VA
22401-6077
US

IV. Provider business mailing address

615 JEFFERSON DAVIS HWY STE 101
FREDERICKSBURG VA
22401-8407
US

V. Phone/Fax

Practice location:
  • Phone: 540-698-0003
  • Fax: 540-212-2660
Mailing address:
  • Phone: 540-698-0003
  • Fax: 540-212-2660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBYN A VAN BRUNT
Title or Position: TREASURER
Credential: PHD
Phone: 540-698-0003