Healthcare Provider Details

I. General information

NPI: 1639674369
Provider Name (Legal Business Name): KELLY SCHMID MCCROWELL PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N. 9TH STREET PSYCHOLOGICAL SERVICES/EXCEPTIONAL EDUCATION
RICHMOND VA
23219
US

IV. Provider business mailing address

10401 WHITE RABBIT RD
NORTH CHESTERFIELD VA
23235-2662
US

V. Phone/Fax

Practice location:
  • Phone: 804-780-7850
  • Fax:
Mailing address:
  • Phone: 804-323-0157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: