Central Virginias Preferred Providers | |
2421 Westwood Ave Ste F Richmond VA 23230-4022 | |
(804) 330-6441 | |
(804) 330-6446 |
Full Name | Central Virginias Preferred Providers |
---|---|
Speciality | Counselor |
Location | 2421 Westwood Ave Ste F, Richmond, Virginia |
Authorized Official Name and Position | Ken Anderson (OWNER) |
Authorized Official Contact | 8045149696 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Central Virginias Preferred Providers 2421 Westwood Ave Ste F Richmond VA 23230-4022 Ph: (804) 330-6441 | Central Virginias Preferred Providers 2421 Westwood Ave Ste F Richmond VA 23230-4022 Ph: (804) 330-6441 |
NPI Number | 1730638107 |
---|---|
Provider Enumeration Date | 09/27/2016 |
Last Update Date | 11/12/2019 |
Medicare PECOS PAC ID | 1557793528 |
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Medicare Enrollment ID | O20191112003342 |
Identifier | Type | State | Issuer |
---|---|---|---|
1730638107 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
Provider Name | Prakash G Ettigi |
---|---|
Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1326057597 PECOS PAC ID: 1456253863 Enrollment ID: I20111027000696 |
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