Healthcare Provider Details

I. General information

NPI: 1205767894
Provider Name (Legal Business Name): ILYANA SERVIS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8003 FRANKLIN FARMS DR RM 101
RICHMOND VA
23229-5107
US

IV. Provider business mailing address

8003 FRANKLIN FARMS DR RM 101
RICHMOND VA
23229-5107
US

V. Phone/Fax

Practice location:
  • Phone: 804-716-0428
  • Fax:
Mailing address:
  • Phone: 804-716-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0906016972
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: