Provider Demographics
NPI:1255762456
Name:CAPITAL PSYCHIATRY AND WELLNESS
Entity type:Organization
Organization Name:CAPITAL PSYCHIATRY AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:III
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:804-338-5094
Mailing Address - Street 1:9200 FOREST HILL AVE
Mailing Address - Street 2:SUITE 6C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-6867
Mailing Address - Country:US
Mailing Address - Phone:804-338-5094
Mailing Address - Fax:804-541-6114
Practice Address - Street 1:9200 FOREST HILL AVE
Practice Address - Street 2:SUITE 6C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-6867
Practice Address - Country:US
Practice Address - Phone:804-338-5094
Practice Address - Fax:804-541-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty