Provider Demographics
NPI:1275551673
Name:CHILDRESS, JOHN FREDERICK III (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREDERICK
Last Name:CHILDRESS
Suffix:III
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:174 HUNTING GREEN LN
Mailing Address - Street 2:
Mailing Address - City:KENTS STORE
Mailing Address - State:VA
Mailing Address - Zip Code:23084-2284
Mailing Address - Country:US
Mailing Address - Phone:434-591-1163
Mailing Address - Fax:540-374-3313
Practice Address - Street 1:810 WESTWOOD OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5121
Practice Address - Country:US
Practice Address - Phone:540-899-4025
Practice Address - Fax:540-374-3313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0810002716103TC0700X, 103TC2200X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service