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General NPI Number Information
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NPI Number | 1750923173
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Entity Type | Organization
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Legal Business Name | ALCHEMY PLLC
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 02/06/2020
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Provider Practice Location Address
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Address Line | 8639 MAYLAND DR STE 102
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City | HENRICO
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State | VA
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Zip | 23294-4752
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Country | US
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Telephone | 804-993-3039
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Fax | 804-447-1953
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Provider Business Mailing Address
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Address Line | 8639 MAYLAND DR STE 102
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City | HENRICO
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State | VA
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Zip | 23294-4752
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Country | US
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Telephone | 804-993-3039
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Fax | 804-447-1953
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JON RANDALL FREDERICK
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Credential | MD
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Telephone | 804-690-2419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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