Healthcare Provider Details

I. General information

NPI: 1073551339
Provider Name (Legal Business Name): DAVID R DILZER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3058 RIVER RD W
GOOCHLAND VA
23063-3202
US

IV. Provider business mailing address

PO BOX 189
GOOCHLAND VA
23063-0189
US

V. Phone/Fax

Practice location:
  • Phone: 804-556-5400
  • Fax: 804-556-5403
Mailing address:
  • Phone: 804-556-5400
  • Fax: 804-556-5403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904000626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: