Healthcare Provider Details

I. General information

NPI: 1174781215
Provider Name (Legal Business Name): ASSOCIATED EDUCATIONS SERVICES OF VA., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 NORTH AVE
RICHMOND VA
23222-3610
US

IV. Provider business mailing address

2817 NORTH AVE
RICHMOND VA
23222-3610
US

V. Phone/Fax

Practice location:
  • Phone: 804-321-2777
  • Fax: 804-321-0920
Mailing address:
  • Phone: 804-321-2777
  • Fax: 804-321-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberBA2096483
License Number StateVA

VIII. Authorized Official

Name: MS. LINDA WOOD HENSLEY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 804-321-2777