Provider Demographics
NPI:1104222132
Name:WEAVER, KADRA (PSYD)
Entity Type:Individual
Prefix:
First Name:KADRA
Middle Name:
Last Name:WEAVER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KADIE
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:4118 E PARHAM RD STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2742
Mailing Address - Country:US
Mailing Address - Phone:804-591-0002
Mailing Address - Fax:
Practice Address - Street 1:4118 E PARHAM RD STE A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-2742
Practice Address - Country:US
Practice Address - Phone:804-591-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-19
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical