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General NPI Number Information
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NPI Number | 1316016645
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Entity Type | Organization
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Legal Business Name | INDIAN RIVER PSYCHOLOGICAL ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6477 COLLEGE PARK SQ SUITE 302
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3611
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Country | US
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Telephone | 757-424-0100
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Fax | 757-424-5623
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Provider Business Mailing Address
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Address Line | 6477 COLLEGE PARK SQ SUITE 302
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-3611
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Country | US
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Telephone | 757-424-0100
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Fax | 757-424-5623
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. I. KIMBERLEE CHUCKER
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Credential | LCSW
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Telephone | 757-424-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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