Healthcare Provider Details

I. General information

NPI: 1689032021
Provider Name (Legal Business Name): VERITAS COLLABORATIVE VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 01/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6627 W BROAD ST SUITE 400
RICHMOND VA
23230-1732
US

IV. Provider business mailing address

411 ROSENEATH RD
RICHMOND VA
23221-2324
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-1019
  • Fax:
Mailing address:
  • Phone: 407-353-6209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: STACIE MCENTYRE
Title or Position: CEO
Credential: MSW, LCSW
Phone: 919-908-9730