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General NPI Number Information
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NPI Number | 1467671446
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Entity Type | Organization
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Legal Business Name | AFFILIATED CLINICAL THERAPISTS
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 4164 VIRGINIA BEACH BLVD STE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1762
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Country | US
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Telephone | 757-623-2228
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Fax | 757-623-7186
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Provider Business Mailing Address
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Address Line | 4164 VIRGINIA BEACH BLVD STE 202
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1762
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Country | US
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Telephone | 757-623-2228
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Fax | 757-623-7186
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE M ROSS
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Credential | PHD
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Telephone | 757-623-2228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810001655
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License Number State | VA
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