Provider Demographics
NPI:1598047185
Name:WERTH, JAMES L JR (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:WERTH
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 MONARCH ROAD
Mailing Address - Street 2:
Mailing Address - City:ST. CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:24282
Mailing Address - Country:US
Mailing Address - Phone:276-383-4428
Mailing Address - Fax:276-383-4927
Practice Address - Street 1:241 MONARCH ROAD
Practice Address - Street 2:
Practice Address - City:ST. CHARLES
Practice Address - State:VA
Practice Address - Zip Code:24282
Practice Address - Country:US
Practice Address - Phone:276-383-4428
Practice Address - Fax:276-383-4927
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003844103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical