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General NPI Number Information
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NPI Number | 1194109371
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Entity Type | Organization
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Legal Business Name | COUNSELING & DIAGNOSTIC SERVICES
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 13801 VILLAGE MILL DR STE 105
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-4382
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Country | US
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Telephone | 804-840-6184
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Fax | 804-592-2667
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Provider Business Mailing Address
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Address Line | 10216 PEPPERHILL LN
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City | RICHMOND
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State | VA
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Zip | 23238-3835
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Country | US
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Telephone | 804-840-6184
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Fax | 804-592-2667
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. ERIC ROBERT BRAEN
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Credential | PH.D.
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Telephone | 804-840-6184
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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 | 0810002140
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License Number State | VA
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