=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518570043
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IPSYCHS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2020
-----------------------------------------------------
Last Update Date | 08/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 OLD BRICK RD STE 138
-----------------------------------------------------
City | GLEN ALLEN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-779-2470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1920 DRESDEN DR NE UNIT 190025
-----------------------------------------------------
City | BROOKHEVEN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-779-2470
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | CHRISTOPHER DOLIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 888-779-2470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------