Provider Demographics
NPI:1912496340
Name:STRATEGIC THERAPY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:STRATEGIC THERAPY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-473-6955
Mailing Address - Street 1:108 DUNCRAIG DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-3335
Mailing Address - Country:US
Mailing Address - Phone:434-473-6955
Mailing Address - Fax:434-237-9454
Practice Address - Street 1:6 WALL ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112-2700
Practice Address - Country:US
Practice Address - Phone:276-258-6707
Practice Address - Fax:434-237-9454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA014-05-001OtherVIRGINIA BOARD OF LICENSING
VA014-03-001OtherVIRGINIA BOARD OF LICENSING