Healthcare Provider Details

I. General information

NPI: 1164596888
Provider Name (Legal Business Name): VIRGINIA INSTITUTE FOR INTERPERSONAL DEVELOPMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3212 SKIPWITH RD SUITE 104
RICHMOND VA
23294-4413
US

IV. Provider business mailing address

13204 THORNRIDGE LN
MIDLOTHIAN VA
23112-4836
US

V. Phone/Fax

Practice location:
  • Phone: 804-308-9133
  • Fax: 804-273-0851
Mailing address:
  • Phone: 804-308-9133
  • Fax: 804-273-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810003638
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number324
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2472
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0830003638
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0810003638
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0810003638
License Number StateVA

VIII. Authorized Official

Name: DR. VICKI VAN CLEAVE
Title or Position: CLINICAL PSYCHOLOGIST - DIRECTOR
Credential: PSY.D.
Phone: 804-308-9133