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General NPI Number Information
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NPI Number | 1528858370
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Entity Type | Organization
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Legal Business Name | 10 FOUR LLC
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Dates
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Enumeration Date | 05/07/2025
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 2711 HULL ST
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City | RICHMOND
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State | VA
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Zip | 23224-3613
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Country | US
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Telephone | 804-306-2587
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Fax |
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Provider Business Mailing Address
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Address Line | 2711 HULL ST
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City | RICHMOND
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State | VA
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Zip | 23224-3613
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Country | US
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Telephone | 804-306-2587
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTION
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Name | CHRISTOPHER BARRINGTON RANDOLPH
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Credential |
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Telephone | 804-305-2587
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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