Provider Demographics
NPI:1093348591
Name:FOUR RIVERS PSYCHOLOGICAL SERVICES, LLC
Entity Type:Organization
Organization Name:FOUR RIVERS PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCP
Authorized Official - Phone:540-300-7004
Mailing Address - Street 1:615 JEFFERSON DAVIS HWY STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8407
Mailing Address - Country:US
Mailing Address - Phone:757-810-0655
Mailing Address - Fax:540-654-1400
Practice Address - Street 1:615 JEFFERSON DAVIS HWY STE 202
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-8407
Practice Address - Country:US
Practice Address - Phone:540-300-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty