MEDICARE: PSYCHIATRIC SERVICES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	0101032227	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134283310
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHIATRIC SERVICES, P.C.

Provider Business Mailing Address
First Line	:	1630 DONNA DR STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6188
Country	:	US
Telephone Number	:	757-425-5050
Fax Number	:	757-425-1389

Provider Business Practice Location Address
First Line	:	1630 DONNA DR STE 102
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6188
Country	:	US
Telephone Number	:	757-425-5050
Fax Number	:	757-425-1389

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANIEL LEE DARBY
Credential	:	M.D.
Telephone Number	:	757-425-5050

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	08/22/2020

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