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General NPI Number Information
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NPI Number | 1801068606
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Entity Type | Organization
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Legal Business Name | FAIRFIELD PSYCHOLOGICAL ASSOC.
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 5265 PROVIDENCE RD SUITE 500
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4206
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Country | US
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Telephone | 757-467-9500
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Fax | 757-467-9560
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Provider Business Mailing Address
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Address Line | 5265 PROVIDENCE RD SUITE 500
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4206
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Country | US
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Telephone | 757-467-9500
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Fax | 757-467-9560
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. GARY ROTFUS
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Credential | LCSW
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Telephone | 757-467-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904000552
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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 | 0904000552
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License Number State | VA
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