Healthcare Provider Details

I. General information

NPI: 1003801028
Provider Name (Legal Business Name): PAMELA KAVANAUGH DOUGLAS MSN,APRN,BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6722 PATTERSON AVE SUITE B
RICHMOND VA
23226-3419
US

IV. Provider business mailing address

6722 PATTERSON AVE SUITE B
RICHMOND VA
23226-3419
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-4000
  • Fax: 804-282-7799
Mailing address:
  • Phone: 804-282-4000
  • Fax: 804-282-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0015000655
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: