Healthcare Provider Details

I. General information

NPI: 1982349809
Provider Name (Legal Business Name): DANA HILLEBRAND ROEBUCK MPS, LCAT, ATR-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2022
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W 24TH ST
RICHMOND VA
23225-3608
US

IV. Provider business mailing address

603 W 24TH ST
RICHMOND VA
23225-3608
US

V. Phone/Fax

Practice location:
  • Phone: 804-362-7967
  • Fax:
Mailing address:
  • Phone: 804-362-7967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number002356
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: