Provider Demographics
NPI:1164596888
Name:VIRGINIA INSTITUTE FOR INTERPERSONAL DEVELOPMENT, PLLC
Entity Type:Organization
Organization Name:VIRGINIA INSTITUTE FOR INTERPERSONAL DEVELOPMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST - DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN CLEAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:804-308-9133
Mailing Address - Street 1:13204 THORNRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-4836
Mailing Address - Country:US
Mailing Address - Phone:804-308-9133
Mailing Address - Fax:804-273-0851
Practice Address - Street 1:3212 SKIPWITH RD
Practice Address - Street 2:SUITE 104
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4413
Practice Address - Country:US
Practice Address - Phone:804-308-9133
Practice Address - Fax:804-273-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003638103TC0700X, 261QM0850X, 261QM0855X
MT324103TC0700X
CO2472103TC0700X
VA0830003638261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Not Answered261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty
Not Answered261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
Not Answered261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Multi-Specialty