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General NPI Number Information
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NPI Number | 1497987101
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Entity Type | Organization
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Legal Business Name | RICHMOND ASSESSMENT AND REFERRAL, A PROFESSIONAL LIMITED COMPANY
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Dates
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Enumeration Date | 08/13/2009
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 7605 FOREST AVE SUITE 414
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City | RICHMOND
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State | VA
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Zip | 23229-4938
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Country | US
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Telephone | 804-592-5300
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Fax | 804-592-5301
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Provider Business Mailing Address
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Address Line | 7605 FOREST AVE SUITE 414
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City | RICHMOND
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State | VA
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Zip | 23229-4938
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Country | US
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Telephone | 804-592-5300
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Fax | 804-592-5301
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. JORDAN M KILGOUR JR.
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Credential | PH.D.
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Telephone | 804-592-5300
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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 | S297122-6
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License Number State | VA
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