Healthcare Provider Details

I. General information

NPI: 1518336148
Provider Name (Legal Business Name): RACHEL GOW, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2015
Last Update Date: 09/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRANITE AVE
RICHMOND VA
23226-2144
US

IV. Provider business mailing address

5501 KINGSBURY RD
RICHMOND VA
23226-2153
US

V. Phone/Fax

Practice location:
  • Phone: 804-814-6821
  • Fax:
Mailing address:
  • Phone: 804-814-6821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number0810004314
License Number StateVA

VIII. Authorized Official

Name: DR. RACHEL GOW
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PHD
Phone: 804-814-6821