Provider Demographics
NPI:1730638107
Name:CENTRAL VIRGINIAS PREFERRED PROVIDERS
Entity Type:Organization
Organization Name:CENTRAL VIRGINIAS PREFERRED PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, MBA
Authorized Official - Phone:804-514-9696
Mailing Address - Street 1:2421 WESTWOOD AVE STE F
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4022
Mailing Address - Country:US
Mailing Address - Phone:804-330-6441
Mailing Address - Fax:804-330-6446
Practice Address - Street 1:2421 WESTWOOD AVE STE F
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-4022
Practice Address - Country:US
Practice Address - Phone:804-330-6441
Practice Address - Fax:804-330-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-27
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty