Healthcare Provider Details

I. General information

NPI: 1831813096
Provider Name (Legal Business Name): PIEDMONT THERAPEUTIC SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3215 ROCK CREEK VILLA DR
QUINTON VA
23141-1656
US

IV. Provider business mailing address

3215 ROCK CREEK VILLA DR
QUINTON VA
23141-1656
US

V. Phone/Fax

Practice location:
  • Phone: 804-314-9462
  • Fax:
Mailing address:
  • Phone: 804-314-9462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DONNA T PURCELL
Title or Position: OWNER/PSYD
Credential: PSYD
Phone: 804-314-9462