Provider Demographics
NPI:1912938705
Name:COLLEY, DWIGHT TOWNSEND (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:TOWNSEND
Last Name:COLLEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 S PANTOPS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8671
Mailing Address - Country:US
Mailing Address - Phone:434-295-6445
Mailing Address - Fax:434-296-1195
Practice Address - Street 1:175 S PANTOPS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8671
Practice Address - Country:US
Practice Address - Phone:434-295-6445
Practice Address - Fax:434-296-1195
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001762103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical