Healthcare Provider Details

I. General information

NPI: 1548926025
Provider Name (Legal Business Name): CATELYN KOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/21/2021
Certification Date: 11/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 W MAIN ST # B
RICHMOND VA
23220-4827
US

IV. Provider business mailing address

3015 PUTNEY RD
HENRICO VA
23228-5043
US

V. Phone/Fax

Practice location:
  • Phone: 301-641-3523
  • Fax:
Mailing address:
  • Phone: 301-641-3523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904013453
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: