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General NPI Number Information
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NPI Number | 1538231881
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Entity Type | Organization
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Legal Business Name | GREATER RICHMOND SCAN CAC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 1001 E BROAD ST LL40
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City | RICHMOND
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State | VA
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Zip | 23219-1928
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Country | US
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Telephone | 804-643-7226
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Fax | 804-643-3529
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Provider Business Mailing Address
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Address Line | 1001 E BROAD ST LL40
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City | RICHMOND
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State | VA
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Zip | 23219-1928
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Country | US
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Telephone | 804-643-7226
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Fax | 804-643-3529
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Authorized Official
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Title or Position | CAC MENTAL HEALTH COORDINATOR
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Name | LISA M WRIGHT
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Credential | M.S.W., L.C.S.W.
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Telephone | 804-643-7226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904003199
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0904005880
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License Number State | VA
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