| Ketamine Rva | |
|
8639 Mayland Dr Ste 102 Henrico VA 23294-4752 | |
| (804) 993-3039 | |
| Not Available |
| Full Name | Ketamine Rva |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 8639 Mayland Dr Ste 102, Henrico, Virginia |
| Authorized Official Name and Position | Jon Frederick (OWNER) |
| Authorized Official Contact | 8049933039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ketamine Rva 8639 Mayland Dr Ste 102 Henrico VA 23294-4752 Ph: () - | Ketamine Rva 8639 Mayland Dr Ste 102 Henrico VA 23294-4752 Ph: (804) 993-3039 |
| NPI Number | 1063234615 |
|---|---|
| Provider Enumeration Date | 10/25/2024 |
| Last Update Date | 10/25/2024 |
| Certification Date | 10/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063234615 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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