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General NPI Number Information
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NPI Number | 1003074493
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Entity Type | Organization
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Legal Business Name | BROAD ROCK COUNSELING AND TRAINING ASSOCIATES
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Dates
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Enumeration Date | 06/02/2008
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 2545 BELLWOOD ROAD SUITE 112
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City | RICHMOND
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State | VA
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Zip | 23237-4481
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Country | US
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Telephone | 804-275-9980
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Fax | 804-275-9981
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Provider Business Mailing Address
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Address Line | 2545 BELLWOOD ROAD SUITE 112
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City | RICHMOND
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State | VA
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Zip | 23237-4481
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Country | US
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Telephone | 804-275-9980
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Fax | 804-275-9981
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. JOANN M. THOMAS-WILSON
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Credential | PHD.
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Telephone | 804-275-9980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810000972
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License Number State | VA
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