Provider Demographics
NPI:1316231814
Name:PSYCHOLOGICAL CONSULTING RESOURCES, PLLC
Entity Type:Organization
Organization Name:PSYCHOLOGICAL CONSULTING RESOURCES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WALD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-333-7501
Mailing Address - Street 1:1 COLUMBUS CTR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6722
Mailing Address - Country:US
Mailing Address - Phone:757-333-7501
Mailing Address - Fax:757-490-7804
Practice Address - Street 1:1 COLUMBUS CTR
Practice Address - Street 2:SUITE 600
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6722
Practice Address - Country:US
Practice Address - Phone:757-333-7501
Practice Address - Fax:757-490-7804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-02
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001650103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9914Medicare PIN