Provider Demographics
NPI:1710397583
Name:COMPREHENSIVE PSYCHOLOGICAL SERVICES AT PENINSULA TOWN CENTER, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PSYCHOLOGICAL SERVICES AT PENINSULA TOWN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-435-0282
Mailing Address - Street 1:860 GREENBRIER CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2640
Mailing Address - Country:US
Mailing Address - Phone:757-547-9007
Mailing Address - Fax:757-548-1928
Practice Address - Street 1:4410 CLAIBORNE SQ E
Practice Address - Street 2:SUITE 334
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2071
Practice Address - Country:US
Practice Address - Phone:757-251-3745
Practice Address - Fax:757-251-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010588252084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty