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General NPI Number Information
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NPI Number | 1689455453
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Entity Type | Organization
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Legal Business Name | EVIDENCE-BASED PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 1 BOARS HEAD LN STE B-6
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4681
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Country | US
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Telephone | 434-230-2233
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BOARS HEAD LN STE B-6
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4681
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Country | US
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Telephone | 434-230-2233
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ELENA HONTORIA TUERK
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Credential |
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Telephone | 434-230-2233
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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 |
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License Number State |
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