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General NPI Number Information
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NPI Number | 1881460319
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Entity Type | Individual
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Provider Name | JUSTIN ANTONIO HARGROVE
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Gender | Male
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 8401 MAYLAND DR STE S
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City | RICHMOND
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State | VA
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Zip | 23294-4648
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Country | US
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Telephone | 202-696-0234
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Fax |
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Provider Business Mailing Address
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Address Line | 4238 TALMADGE CIR
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City | CAMP SPRINGS
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State | MD
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Zip | 20746-4279
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Country | US
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Telephone | 202-696-0234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0701015491
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License Number State | VA
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