Healthcare Provider Details

I. General information

NPI: 1003867557
Provider Name (Legal Business Name): JOHN CHRISTIAN COLLETTI PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9515 CATESBY LN
RICHMOND VA
23238-4453
US

IV. Provider business mailing address

9515 CATESBY LN
RICHMOND VA
23238-4453
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-7500
  • Fax: 804-741-7900
Mailing address:
  • Phone: 804-741-7500
  • Fax: 804-741-7900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810002516
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: