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General NPI Number Information
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NPI Number | 1255762456
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Entity Type | Organization
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Legal Business Name | CAPITAL PSYCHIATRY AND WELLNESS
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 9200 FOREST HILL AVE SUITE 6C
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City | RICHMOND
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State | VA
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Zip | 23235-6867
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Country | US
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Telephone | 804-338-5094
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Fax | 804-541-6114
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Provider Business Mailing Address
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Address Line | 9200 FOREST HILL AVE SUITE 6C
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City | RICHMOND
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State | VA
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Zip | 23235-6867
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Country | US
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Telephone | 804-338-5094
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Fax | 804-541-6114
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT ANTHONY YOUNG III
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Credential | PMHNP
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Telephone | 804-338-5094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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