Provider Demographics
NPI:1922284512
Name:ASSOCIATES IN CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY, PC
Entity Type:Organization
Organization Name:ASSOCIATES IN CLINICAL PSYCHOLOGY AND PSYCHOTHERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WENZEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-273-9687
Mailing Address - Street 1:3108 N PARHAM RD
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4421
Mailing Address - Country:US
Mailing Address - Phone:804-273-9687
Mailing Address - Fax:804-270-0474
Practice Address - Street 1:3108 N PARHAM RD
Practice Address - Street 2:SUITE 200A
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4421
Practice Address - Country:US
Practice Address - Phone:804-273-9687
Practice Address - Fax:804-270-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001243251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO9255Medicare UPIN