Healthcare Provider Details

I. General information

NPI: 1699365759
Provider Name (Legal Business Name): ERIC HUNTER MANSFIELD LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2004 BREMO RD STE 201
RICHMOND VA
23226-2442
US

IV. Provider business mailing address

4201 HERON POINTE CT
MOSELEY VA
23120-1440
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-2000
  • Fax: 804-272-2030
Mailing address:
  • Phone: 804-240-9272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904012624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: