Provider Demographics
NPI:1093383259
Name:ALBEMARLE DYNAMIC PSYCHIATRY LLC
Entity Type:Organization
Organization Name:ALBEMARLE DYNAMIC PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-996-7605
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:CROZET
Mailing Address - State:VA
Mailing Address - Zip Code:22932-0028
Mailing Address - Country:US
Mailing Address - Phone:434-996-7605
Mailing Address - Fax:866-289-5249
Practice Address - Street 1:325 FOUR LEAF LN STE 12
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-9203
Practice Address - Country:US
Practice Address - Phone:434-466-1588
Practice Address - Fax:866-289-5249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty