Healthcare Provider Details

I. General information

NPI: 1992095525
Provider Name (Legal Business Name): DREAMEL SPADY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2011
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8545 PATTERSON AVE STE 201
HENRICO VA
23229-6455
US

IV. Provider business mailing address

8545 PATTERSON AVE STE 201
HENRICO VA
23229-6455
US

V. Phone/Fax

Practice location:
  • Phone: 804-537-2217
  • Fax: 804-442-7111
Mailing address:
  • Phone: 804-537-2217
  • Fax: 804-442-7111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006941
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: