Provider Demographics
NPI:1497853527
Name:INDEPENDENCE THERAPY CENTER P C
Entity Type:Organization
Organization Name:INDEPENDENCE THERAPY CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARANJIT
Authorized Official - Middle Name:P
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-473-8533
Mailing Address - Street 1:700 INDEPENDENCE CIR
Mailing Address - Street 2:SUITE 3D
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6405
Mailing Address - Country:US
Mailing Address - Phone:757-473-8533
Mailing Address - Fax:757-456-0616
Practice Address - Street 1:700 INDEPENDENCE CIR
Practice Address - Street 2:SUITE 3D
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6405
Practice Address - Country:US
Practice Address - Phone:757-473-8533
Practice Address - Fax:757-456-0616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAAS1394763101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC02945Medicare PIN