| 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 |
|---|---|
| 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 | Philip C Boulanger |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1083685366 PECOS PAC ID: 6507881901 Enrollment ID: I20051013000716 |
| Provider Name | Deborah J Dougherty |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760487821 PECOS PAC ID: 9739166331 Enrollment ID: I20101201001361 |
| Provider Name | Prakash G Ettigi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1326057597 PECOS PAC ID: 1456253863 Enrollment ID: I20111027000696 |
| Provider Name | Hollie Miles |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760936918 PECOS PAC ID: 8527430842 Enrollment ID: I20230215001605 |
| Provider Name | Arianna Ayala |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1154905958 PECOS PAC ID: 6507301850 Enrollment ID: I20240711001656 |
| Provider Name | Terri Shawanda Wimbush |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144802455 PECOS PAC ID: 5890230601 Enrollment ID: I20240716002616 |
| Provider Name | Brittany Brown-price |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669010682 PECOS PAC ID: 5890233092 Enrollment ID: I20240820000604 |
| Provider Name | Keshia Diane Ingram |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043824675 PECOS PAC ID: 0345789467 Enrollment ID: I20240903001896 |
| Provider Name | Alfonso Bermea |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1588842660 PECOS PAC ID: 3173063195 Enrollment ID: I20240905001279 |
| Provider Name | Kayo Tokizawa |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669299509 PECOS PAC ID: 8426581232 Enrollment ID: I20241101000213 |
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