Healthcare Provider Details

I. General information

NPI: 1457785388
Provider Name (Legal Business Name): VIRGINIA INTERVENTIONAL PSYCHIATRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5231 HICKORY PARK DR SUITE C
GLEN ALLEN VA
23059-2619
US

IV. Provider business mailing address

5231 HICKORY PARK DR STE C
GLEN ALLEN VA
23059-2619
US

V. Phone/Fax

Practice location:
  • Phone: 804-980-7529
  • Fax: 804-980-7794
Mailing address:
  • Phone: 804-464-8471
  • Fax: 804-980-7794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101235202
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: BRYCE NEUMANN
Title or Position: VICE PRESIDENT
Credential:
Phone: 804-980-7520