Healthcare Provider Details

I. General information

NPI: 1104532076
Provider Name (Legal Business Name): RVA ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COALFIELD RD
MIDLOTHIAN VA
23114-4403
US

IV. Provider business mailing address

5407 PARK AVE
RICHMOND VA
23226-2031
US

V. Phone/Fax

Practice location:
  • Phone: 540-607-5054
  • Fax:
Mailing address:
  • Phone: 757-717-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE R DAMICO
Title or Position: OWNER
Credential:
Phone: 757-717-7393