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General NPI Number Information
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NPI Number | 1376054395
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Entity Type | Organization
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Legal Business Name | VIRGINIA CALYX PROFESSIONAL SERVICES, , LLC
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Dates
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Enumeration Date | 10/17/2017
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Last Update Date | 10/17/2017
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Provider Practice Location Address
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Address Line | 681 HIOAKS RD STE C
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City | RICHMOND
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State | VA
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Zip | 23225-4043
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Country | US
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Telephone | 804-729-9248
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Fax |
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Provider Business Mailing Address
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Address Line | 681 HIOAKS RD STE C
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City | RICHMOND
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State | VA
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Zip | 23225-4043
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Country | US
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Telephone | 804-729-9248
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Fax |
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Authorized Official
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Title or Position | CORP. DIRECTOR OF CLINICAL SERVICES
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Name | MS. NATALIE ORME WATERS
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Credential | LSW
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Telephone | 804-729-9248
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | 090300258
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License Number State | VA
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