Provider Demographics
NPI:1033251210
Name:STALEY, THOMAS BELVIN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BELVIN
Last Name:STALEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10299 WOODMAN RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-4419
Mailing Address - Country:US
Mailing Address - Phone:804-727-8500
Mailing Address - Fax:804-727-8580
Practice Address - Street 1:4915 RADFORD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3528
Practice Address - Country:US
Practice Address - Phone:804-359-3370
Practice Address - Fax:804-359-1649
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040021531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945131OtherVIRGINIA PREMIER
VA258063OtherANTHEM
VA2169301OtherMAMSI
VAO83205OtherOPTIMA
VA258063OtherANTHEM