Healthcare Provider Details

I. General information

NPI: 1912692096
Provider Name (Legal Business Name): CREDENCE BEHAVIORAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 06/03/2023
Certification Date: 06/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 WIGGINGTON RD
LYNCHBURG VA
24502-4619
US

IV. Provider business mailing address

14803 FOREST RD UNIT 2452
FOREST VA
24551-9052
US

V. Phone/Fax

Practice location:
  • Phone: 434-253-0212
  • Fax:
Mailing address:
  • Phone: 434-253-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084B0002X
TaxonomyObesity Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SANKET RAJARAM DHAT
Title or Position: CEO AND FOUNDER
Credential: MD
Phone: 217-381-4633