Healthcare Provider Details

I. General information

NPI: 1093251936
Provider Name (Legal Business Name): ERICA HURLEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 HIOAKS RD STE E
RICHMOND VA
23225-4043
US

IV. Provider business mailing address

PO BOX 13650
RICHMOND VA
23225-8650
US

V. Phone/Fax

Practice location:
  • Phone: 804-482-0162
  • Fax:
Mailing address:
  • Phone: 804-482-0162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810005427
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: