Healthcare Provider Details

I. General information

NPI: 1003034125
Provider Name (Legal Business Name): J. PATRICK SLIFKA LCSW, CAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 MONUMENT AVENUE SUITE 201
RICHMOND VA
23230
US

IV. Provider business mailing address

14500 TEALBY DRIVE
MIDLOTHIAN VA
23112
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-4676
  • Fax: 804-497-4677
Mailing address:
  • Phone: 804-652-8266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005007
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: