Provider Demographics
NPI:1912692096
Name:CREDENCE BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:CREDENCE BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANKET
Authorized Official - Middle Name:RAJARAM
Authorized Official - Last Name:DHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-381-4633
Mailing Address - Street 1:14803 FOREST RD UNIT 2452
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-9052
Mailing Address - Country:US
Mailing Address - Phone:434-253-0212
Mailing Address - Fax:
Practice Address - Street 1:115 WIGGINGTON RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4619
Practice Address - Country:US
Practice Address - Phone:434-253-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084B0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyObesity MedicineGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric PsychiatryGroup - Multi-Specialty