Healthcare Provider Details

I. General information

NPI: 1114908886
Provider Name (Legal Business Name): JUDITH L CAIN-OLIVER DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 08/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 PLAINVIEW CENTER
POWHATAN VA
23139
US

IV. Provider business mailing address

2156 PLAINVIEW CENTER
POWHATAN VA
23139
US

V. Phone/Fax

Practice location:
  • Phone: 804-598-9577
  • Fax: 804-598-0084
Mailing address:
  • Phone: 804-598-9577
  • Fax: 804-598-0084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810000169
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: