Provider Demographics
NPI:1477512416
Name:CENTRAL VIRGINIA FAMILY PSYCHIATRY PC
Entity Type:Organization
Organization Name:CENTRAL VIRGINIA FAMILY PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:WOOLDRIDGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:804-732-1527
Mailing Address - Street 1:PO BOX 11786
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-0186
Mailing Address - Country:US
Mailing Address - Phone:804-672-4836
Mailing Address - Fax:804-213-9783
Practice Address - Street 1:43 RIVES RD
Practice Address - Street 2:SUITE B
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9255
Practice Address - Country:US
Practice Address - Phone:804-732-1527
Practice Address - Fax:804-732-8210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C08729OtherGROUP MEDICARE NUMBER