Healthcare Provider Details

I. General information

NPI: 1598129892
Provider Name (Legal Business Name): STRATAVATE RESOURCE GROUP OF VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2717 GRAND MEADOWS CT
RICHMOND VA
23223-2174
US

IV. Provider business mailing address

2717 GRAND MEADOWS CT
RICHMOND VA
23223-2174
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-6944
  • Fax: 804-918-3062
Mailing address:
  • Phone: 804-497-6944
  • Fax: 804-918-3062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number198003001
License Number StateVA

VIII. Authorized Official

Name: NAZARELL WILLIAMS
Title or Position: CEO
Credential: MS LPC
Phone: 804-497-6694