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General NPI Number Information
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NPI Number | 1033251210
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Entity Type | Individual
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Provider Name | THOMAS BELVIN STALEY LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 4915 RADFORD AVE
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City | RICHMOND
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State | VA
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Zip | 23230-3528
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Country | US
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Telephone | 804-359-3370
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Fax | 804-359-1649
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Provider Business Mailing Address
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Address Line | 10299 WOODMAN RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-4419
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Country | US
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Telephone | 804-727-8500
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Fax | 804-727-8580
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904002153
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License Number State | VA
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