Healthcare Provider Details

I. General information

NPI: 1508355777
Provider Name (Legal Business Name): TERESA CRENSHAW ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2018
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 HARTMAN ST
RICHMOND VA
23223-2458
US

IV. Provider business mailing address

PO BOX 23120
RICHMOND VA
23223-0420
US

V. Phone/Fax

Practice location:
  • Phone: 804-343-6500
  • Fax: 804-343-6515
Mailing address:
  • Phone: 804-343-6500
  • Fax: 804-343-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000425
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: