Provider Demographics
NPI:1477091247
Name:VIRGINIA CENTER FOR ADDICTION MEDICINE
Entity Type:Organization
Organization Name:VIRGINIA CENTER FOR ADDICTION MEDICINE
Other - Org Name:MASTER CENTER FOR ADDICTION MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-332-5950
Mailing Address - Street 1:4212 PARK PLACE CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3314
Mailing Address - Country:US
Mailing Address - Phone:804-332-5950
Mailing Address - Fax:804-728-1086
Practice Address - Street 1:4212 PARK PLACE CT
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3314
Practice Address - Country:US
Practice Address - Phone:804-332-5950
Practice Address - Fax:804-728-1086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246355207RA0401X
VA01010150302084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty