Healthcare Provider Details

I. General information

NPI: 1104222132
Provider Name (Legal Business Name): KADRA WEAVER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KADIE WEAVER PSYD

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4118 E PARHAM RD STE A
RICHMOND VA
23228-2742
US

IV. Provider business mailing address

4118 E PARHAM RD STE A
RICHMOND VA
23228-2742
US

V. Phone/Fax

Practice location:
  • Phone: 804-591-0002
  • Fax:
Mailing address:
  • Phone: 804-591-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005112
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: