Healthcare Provider Details

I. General information

NPI: 1700894466
Provider Name (Legal Business Name): VIRGINIA SOUTH PSYCHIATRIC & FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805
US

IV. Provider business mailing address

269 MEDICAL PARK BLVD
PETERSBURG VA
23805
US

V. Phone/Fax

Practice location:
  • Phone: 804-861-0700
  • Fax: 804-863-4626
Mailing address:
  • Phone: 804-518-6504
  • Fax: 804-863-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTHONY JOSEPH VADELLA
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 804-518-6504