Provider Demographics
NPI:1811419286
Name:HAXTER, ROBERT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:HAXTER
Suffix:
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 1:325 FOUR LEAF LN STE 12
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9203
Mailing Address - Country:US
Mailing Address - Phone:434-466-1588
Mailing Address - Fax:
Practice Address - Street 1:300 CLAREMONT LN STE 103
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3455
Practice Address - Country:US
Practice Address - Phone:434-466-1588
Practice Address - Fax:866-289-5249
Is Sole Proprietor?:No
Enumeration Date:2017-07-07
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005874103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810005874OtherSTATE LICENSING BOARD