Healthcare Provider Details

I. General information

NPI: 1083334791
Provider Name (Legal Business Name): TIKVAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8923 OLD HOLLY RD
RICHMOND VA
23235
US

IV. Provider business mailing address

2711 BUFORD RD # 129
NORTH CHESTERFIELD VA
23235-2423
US

V. Phone/Fax

Practice location:
  • Phone: 804-252-0512
  • Fax:
Mailing address:
  • Phone: 804-252-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA R WEISMAN
Title or Position: OWNER
Credential: PSY.D.
Phone: 804-252-0512