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General NPI Number Information
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NPI Number | 1477616597
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL CENTER PC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 12/07/2010
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Provider Practice Location Address
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Address Line | 505 S INDEPENDENCE BLVD SUITE 207
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-1150
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Country | US
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Telephone | 757-490-3880
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Fax | 757-497-4197
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Provider Business Mailing Address
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Address Line | PO BOX 2038
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City | VIRGINIA BEACH
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State | VA
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Zip | 23450-2038
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Country | US
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Telephone | 757-490-3880
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Fax | 757-497-4197
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | RICHARD J SHEA
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Credential | PHD
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Telephone | 757-490-3880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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