Healthcare Provider Details

I. General information

NPI: 1477512416
Provider Name (Legal Business Name): CENTRAL VIRGINIA FAMILY PSYCHIATRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 03/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 RIVES RD SUITE B
PETERSBURG VA
23805-9255
US

IV. Provider business mailing address

PO BOX 11786
RICHMOND VA
23230-0186
US

V. Phone/Fax

Practice location:
  • Phone: 804-732-1527
  • Fax: 804-732-8210
Mailing address:
  • Phone: 804-672-4836
  • Fax: 804-213-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: JAMES W WOOLDRIDGE JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 804-732-1527