Healthcare Provider Details

I. General information

NPI: 1861404881
Provider Name (Legal Business Name): DAVID ISRAEL PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 STAPLES MILL RD STE 209
RICHMOND VA
23230-2917
US

IV. Provider business mailing address

2120 STAPLES MILL RD STE 209
RICHMOND VA
23230-2917
US

V. Phone/Fax

Practice location:
  • Phone: 804-716-2629
  • Fax:
Mailing address:
  • Phone: 804-288-1308
  • Fax: 804-288-1058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number0810000634
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: