Healthcare Provider Details

I. General information

NPI: 1780679027
Provider Name (Legal Business Name): ALEXANDER TAYLOR LEVERTY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 01/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9020 STONY POINT PKWY STE 240
RICHMOND VA
23235
US

IV. Provider business mailing address

9020 STONY POINT PKWY STE 240
RICHMOND VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-5236
  • Fax: 804-282-5547
Mailing address:
  • Phone: 804-282-5236
  • Fax: 804-282-5547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004547
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: