Healthcare Provider Details

I. General information

NPI: 1841490976
Provider Name (Legal Business Name): WILLIAM J FAETH LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 STAPLES MILL RD STE 100
RICHMOND VA
23230-3631
US

IV. Provider business mailing address

1506 STAPLES MILL RD STE 100
RICHMOND VA
23230-3631
US

V. Phone/Fax

Practice location:
  • Phone: 804-355-8800
  • Fax:
Mailing address:
  • Phone: 804-355-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002979
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: