Healthcare Provider Details

I. General information

NPI: 1356836696
Provider Name (Legal Business Name): CHANDRA HULCHER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 06/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 FITZHUGH AVE
RICHMOND VA
23230-3510
US

IV. Provider business mailing address

711 LAKEWATER DR
RICHMOND VA
23229-6261
US

V. Phone/Fax

Practice location:
  • Phone: 804-353-8958
  • Fax: 804-353-0837
Mailing address:
  • Phone: 804-350-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904007586
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: