Healthcare Provider Details

I. General information

NPI: 1346471505
Provider Name (Legal Business Name): RICHARD S LUCK EDD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 08/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 GAYTON RD SUITE 181
RICHMOND VA
23238-4907
US

IV. Provider business mailing address

9702 GAYTON RD SUITE 181
RICHMOND VA
23238-4907
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 Number0715000001
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: