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General NPI Number Information
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NPI Number | 1043466394
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Entity Type | Organization
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Legal Business Name | CENTER FOR PSYCHOLOGICAL ASSESSMENT AND THERAPEUTICS
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 08/18/2008
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Provider Practice Location Address
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Address Line | 3500 VIRGINIA BEACH BLVD SUITE 511
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4445
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Country | US
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Telephone | 757-340-1164
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Fax | 757-340-1195
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Provider Business Mailing Address
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Address Line | 3500 VIRGINIA BEACH BLVD SUITE 511
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4445
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Country | US
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Telephone | 757-340-1164
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Fax | 757-340-1195
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Authorized Official
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Title or Position | OWNER / PARTNER
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Name | DR. GLENN REX MILLER
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Credential | PH.D
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Telephone | 757-340-1164
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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 | 0810000350
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number | 0810000350
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904005428
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 0810000350
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License Number State | VA
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