Healthcare Provider Details

I. General information

NPI: 1396654034
Provider Name (Legal Business Name): CARLY ANNE POLOSKEY LMHC, MT-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE 11579
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE 11579
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 757-204-2691
  • Fax:
Mailing address:
  • Phone: 757-204-2691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH28344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: