Provider Demographics
NPI:1598872590
Name:CHILDHOOD LANG CNTR AT RICH. INC.
Entity Type:Organization
Organization Name:CHILDHOOD LANG CNTR AT RICH. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:OLIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:804-266-6699
Mailing Address - Street 1:4202 HERMITAGE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-3755
Mailing Address - Country:US
Mailing Address - Phone:804-266-6699
Mailing Address - Fax:804-264-5988
Practice Address - Street 1:4202 HERMITAGE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-3755
Practice Address - Country:US
Practice Address - Phone:804-266-6699
Practice Address - Fax:804-264-5988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3822946OtherCIGNA PPO
VA49-7877-3Medicaid
VA195246OtherBCBS
VA052550OtherBCBS
VA94-50297Medicaid
VA94-50297Medicaid