Healthcare Provider Details

I. General information

NPI: 1164313805
Provider Name (Legal Business Name): PATRICK ANTONINO PAGANO CSAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2025
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N 28TH ST STE 101
RICHMOND VA
23223-5311
US

IV. Provider business mailing address

2821 HILLIARD RD APT K
RICHMOND VA
23228-4465
US

V. Phone/Fax

Practice location:
  • Phone: 804-521-0050
  • Fax:
Mailing address:
  • Phone: 913-689-9741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103831
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: