Healthcare Provider Details

I. General information

NPI: 1407795594
Provider Name (Legal Business Name): BASELINE PSYCHOLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE 8140
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

PO BOX 6034
VIRGINIA BEACH VA
23456-0034
US

V. Phone/Fax

Practice location:
  • Phone: 619-839-9938
  • Fax:
Mailing address:
  • Phone: 619-839-9938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: BARBARA SOTO COLLAZO
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 619-839-9938