=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295533677
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE PSYCHIATRY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/03/2025
-----------------------------------------------------
Last Update Date | 03/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12482 TITUS COVE LNDG
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23314-6018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-231-9699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8401 MAYLAND DR STE A
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23294-4648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/ PA
-----------------------------------------------------
Name | ASHLEY LYONS
-----------------------------------------------------
Credential | PA
-----------------------------------------------------
Telephone | 757-231-9699
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------