Healthcare Provider Details

I. General information

NPI: 1790830479
Provider Name (Legal Business Name): GLEN FOREST ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 FOREST AVE SUITE 201
RICHMOND VA
23226-3792
US

IV. Provider business mailing address

7301 FOREST AVE. SUITE 201
RICHMOND VA
23226
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-4121
  • Fax: 804-285-4123
Mailing address:
  • Phone: 804-285-4121
  • Fax: 804-285-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. PHYLLIS A BERG
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 804-285-4121