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General NPI Number Information
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NPI Number | 1316470503
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Entity Type | Organization
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Legal Business Name | CENTER FOR MIND AND BODY HEALTH
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 408 E MARKET ST SUITE 201-B
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22902-5261
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Country | US
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Telephone | 434-566-0846
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Fax | 434-202-5441
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Provider Business Mailing Address
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Address Line | 2174 WHISPERING HOLLOW LN
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-3590
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Country | US
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Telephone | 434-566-0846
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Fax | 434-202-5441
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Authorized Official
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Title or Position | DIRECTOR, CLINICAL PSYCHOLOGIST
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Name | DR. VIVIAN MARIE RODRIGUEZ ARCHILLA
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Credential | PHD, LCP
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Telephone | 434-566-0846
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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 | 0810005495
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810005495
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 0810005495
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | 0810005495
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License Number State | VA
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