Healthcare Provider Details

I. General information

NPI: 1417435447
Provider Name (Legal Business Name): ERIN D. KURTZ LCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2018
Last Update Date: 08/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD # 116B
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

9491 TRACEY LYNNE CIR
GLEN ALLEN VA
23060-3785
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number0810005742
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005742
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: