Provider Demographics
NPI:1336244201
Name:POEHAILOS DUPONT & ASSOC
Entity Type:Organization
Organization Name:POEHAILOS DUPONT & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:D
Authorized Official - Last Name:DUPONT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:434-220-4686
Mailing Address - Street 1:887B RIO EAST COURT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901
Mailing Address - Country:US
Mailing Address - Phone:434-220-4686
Mailing Address - Fax:434-220-4687
Practice Address - Street 1:887B RIO EAST COURT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901
Practice Address - Country:US
Practice Address - Phone:434-220-4686
Practice Address - Fax:434-220-4687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002481101Y00000X
VA0810002867103T00000X
VA0810001910103TC2200X
VA0810002135103TC2200X
VA09040038371041C0700X
VA09040005471041C0700X
VA09040063011041C0700X
VA01012334382084P0800X
VA01010472232084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA101YP2500XOtherPSYCHOLOGIST CHILD, YOUTH