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12801 Iron Bridge Rd Ste 400 Chester VA 23831-1669 | |
| (804) 768-0295 | |
| (804) 768-8001 |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 12801 Iron Bridge Rd Ste 400, Chester, Virginia |
| Authorized Official Name and Position | Susan Varner (CREDENTIALING ASSOCIATE) |
| Authorized Official Contact | 8047680295 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
12801 Iron Bridge Rd Ste 400 Chester VA 23831-1669 Ph: (804) 768-0295 | 12801 Iron Bridge Rd Ste 400 Chester VA 23831-1669 Ph: (804) 768-0295 |
| NPI Number | 1568912707 |
|---|---|
| Provider Enumeration Date | 10/12/2016 |
| Last Update Date | 10/12/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568912707 | NPI | - | NPPES |
| 0000779934 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | 0810001349 (Virginia) | Primary |
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