Provider Demographics
NPI:1457084899
Name:PRINCE, EMILY BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:BARBARA
Last Name:PRINCE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10124 W BROAD ST STE H
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3330
Mailing Address - Country:US
Mailing Address - Phone:804-420-8620
Mailing Address - Fax:
Practice Address - Street 1:10124 W BROAD ST STE H
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3330
Practice Address - Country:US
Practice Address - Phone:804-420-8620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-04
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810007885103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical