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General NPI Number Information
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NPI Number | 1306515812
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Entity Type | Organization
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Legal Business Name | PRIME PSYCH VA, LLC
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Dates
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Enumeration Date | 09/08/2021
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 7751 SQUIRREL LEVEL RD
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City | NORTH DINWIDDIE
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State | VA
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Zip | 23803-7637
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Country | US
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Telephone | 804-695-6633
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Fax | 855-978-2324
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Provider Business Mailing Address
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Address Line | 1050 TEMPLE AVE # 524
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2981
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Country | US
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Telephone | 804-695-6633
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. FRANK ROBERT ROSE
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Credential | PSYD
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Telephone | 804-695-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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