Healthcare Provider Details

I. General information

NPI: 1801736681
Provider Name (Legal Business Name): ADDISON D. MONROE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 W 25TH ST
RICHMOND VA
23225-3803
US

IV. Provider business mailing address

409 W 25TH ST
RICHMOND VA
23225-3803
US

V. Phone/Fax

Practice location:
  • Phone: 717-994-0770
  • Fax:
Mailing address:
  • Phone: 717-994-0770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810009337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: