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General NPI Number Information
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NPI Number | 1912692096
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Entity Type | Organization
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Legal Business Name | CREDENCE BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 04/06/2023
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Last Update Date | 06/03/2023
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Provider Practice Location Address
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Address Line | 115 WIGGINGTON RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-4619
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Country | US
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Telephone | 434-253-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 14803 FOREST RD UNIT 2452
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City | FOREST
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State | VA
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Zip | 24551-9052
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Country | US
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Telephone | 434-253-0212
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Fax |
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Authorized Official
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Title or Position | CEO AND FOUNDER
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Name | DR. SANKET RAJARAM DHAT
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Credential | MD
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Telephone | 217-381-4633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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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 | 2084B0002X
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Taxonomy Name | Obesity Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084B0040X
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Taxonomy Name | Behavioral Neurology & Neuropsychiatry Physician
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License Number |
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License Number State |
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