Provider Demographics
NPI:1205888393
Name:LUDFORD, GEOFFREY WAYNE (EDD)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:WAYNE
Last Name:LUDFORD
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 ACADEMY AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3205
Mailing Address - Country:US
Mailing Address - Phone:757-483-6404
Mailing Address - Fax:757-483-0737
Practice Address - Street 1:3300 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3205
Practice Address - Country:US
Practice Address - Phone:757-483-6404
Practice Address - Fax:757-483-0737
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002140101YP2500X
VA0717000203106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005409357Medicaid
VA214324OtherANTHEM BCBS
VAO81365OtherSENTARA/OPTIMA HEALTH INS