Provider Demographics
NPI:1871219170
Name:PSYCHOTHERAPY ASSOCIATES OF VIRGINIA LLC
Entity type:Organization
Organization Name:PSYCHOTHERAPY ASSOCIATES OF VIRGINIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:B
Authorized Official - Last Name:PANISSIDI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-237-9377
Mailing Address - Street 1:232 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:VA
Mailing Address - Zip Code:23851-2339
Mailing Address - Country:US
Mailing Address - Phone:757-237-9377
Mailing Address - Fax:800-721-9807
Practice Address - Street 1:232 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:VA
Practice Address - Zip Code:23851-2339
Practice Address - Country:US
Practice Address - Phone:757-237-9377
Practice Address - Fax:800-721-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty