Provider Demographics
NPI:1043466394
Name:CENTER FOR PSYCHOLOGICAL ASSESSMENT AND THERAPEUTICS
Entity type:Organization
Organization Name:CENTER FOR PSYCHOLOGICAL ASSESSMENT AND THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:REX
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-340-1164
Mailing Address - Street 1:3500 VIRGINIA BEACH BLVD
Mailing Address - Street 2:SUITE 511
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4445
Mailing Address - Country:US
Mailing Address - Phone:757-340-1164
Mailing Address - Fax:757-340-1195
Practice Address - Street 1:3500 VIRGINIA BEACH BLVD
Practice Address - Street 2:SUITE 511
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4445
Practice Address - Country:US
Practice Address - Phone:757-340-1164
Practice Address - Fax:757-340-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810000350103T00000X, 103TC0700X, 103TF0200X
VA09040054281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty