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General NPI Number Information
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NPI Number | 1205120573
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Entity Type | Organization
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Legal Business Name | WILLIAMSBURG PSYCHIATRY AND COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 06/04/2011
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Last Update Date | 06/04/2011
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Provider Practice Location Address
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Address Line | 1101 PROFESSIONAL DR SUITE C
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3301
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Country | US
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Telephone | 757-634-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 PROFESSIONAL DR SUITE C
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3301
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Country | US
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Telephone | 757-634-6688
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. ALFONSO LOPEZ-CARDONA
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Credential | M.D.
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Telephone | 757-620-2327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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