Provider Demographics
NPI:1497987101
Name:RICHMOND ASSESSMENT AND REFERRAL, A PROFESSIONAL LIMITED COMPANY
Entity type:Organization
Organization Name:RICHMOND ASSESSMENT AND REFERRAL, A PROFESSIONAL LIMITED COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KILGOUR
Authorized Official - Suffix:JR
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-592-5300
Mailing Address - Street 1:7605 FOREST AVE
Mailing Address - Street 2:SUITE 414
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-4938
Mailing Address - Country:US
Mailing Address - Phone:804-592-5300
Mailing Address - Fax:804-592-5301
Practice Address - Street 1:7605 FOREST AVE
Practice Address - Street 2:SUITE 414
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4938
Practice Address - Country:US
Practice Address - Phone:804-592-5300
Practice Address - Fax:804-592-5301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS297122-6103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty