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General NPI Number Information
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NPI Number | 1619797032
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Entity Type | Organization
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Legal Business Name | DEVIL DOG RANCH
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 4811 WAYMACKS RD
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City | CHARLES CITY
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State | VA
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Zip | 23030-2422
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Country | US
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Telephone | 804-921-4962
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Fax |
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Provider Business Mailing Address
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Address Line | 4811 WAYMACKS RD
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City | CHARLES CITY
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State | VA
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Zip | 23030-2422
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Country | US
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Telephone | 804-921-4962
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | TINA SILVA
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Credential |
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Telephone | 804-921-4962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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