Provider Demographics
NPI:1598129892
Name:STRATAVATE RESOURCE GROUP OF VIRGINIA
Entity Type:Organization
Organization Name:STRATAVATE RESOURCE GROUP OF VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAZARELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MS LPC
Authorized Official - Phone:804-497-6694
Mailing Address - Street 1:2717 GRAND MEADOWS CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-2174
Mailing Address - Country:US
Mailing Address - Phone:804-497-6944
Mailing Address - Fax:804-918-3062
Practice Address - Street 1:2717 GRAND MEADOWS CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-2174
Practice Address - Country:US
Practice Address - Phone:804-497-6944
Practice Address - Fax:804-918-3062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
VA198003001251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty