Healthcare Provider Details

I. General information

NPI: 1346132982
Provider Name (Legal Business Name): TESSERACT VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 N PARHAM RD STE 120
RICHMOND VA
23294-4422
US

IV. Provider business mailing address

2810 N PARHAM RD STE 120
RICHMOND VA
23294-4422
US

V. Phone/Fax

Practice location:
  • Phone: 804-288-1881
  • Fax:
Mailing address:
  • Phone: 804-288-1881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN WISEMAN
Title or Position: OWNER
Credential: MD
Phone: 804-323-8282