Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 2084P0800X | Psychiatry & Neurology | Psychiatry | 0101245418 | VIRGINIA | No |
| 2 | 2084P0804X | Psychiatry & Neurology | Child & Adolescent Psychiatry | 0101245418 | VIRGINIA | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 1164683991 | OTHER | VIRGINIA | MANAGED HEALTH NETWORK/TRICARE |
| 2 | 472386 | OTHER | VIRGINIA | ANTHEM BC/BS |
| 3 | PAR | OTHER | VIRGINIA | MULTIPLAN |
| 4 | PAR | OTHER | VIRGINIA | VALUE OPTIONS |
| 5 | PAR | OTHER | VIRGINIA | MAGELLAN HEALTH SERVICES |
| 6 | PAR | OTHER | VIRGINIA | AETNA |
| 7 | PAR | OTHER | VIRGINIA | UNITED BEHAVIORAL HEALTH |
| 8 | PAR | OTHER | VIRGINIA | CORVEL |
| 9 | 1164683991 | OTHER | VIRGINIA | OPTIMA BEHAVIORAL HEALTH |
| 10 | 1164683991 | OTHER | VIRGINIA | COVENTRY HEALTH NETWORK |
| 11 | PAR | OTHER | VIRGINIA | USA MANAGED CARE |
| 12 | PAR | OTHER | VIRGINIA | CIGNA BEHAVIORAL HEALTH |
| 13 | 1164683991 | OTHER | VIRGINIA | VIRGINIA PREMIER HEALTH PLAN |
| 14 | 5920578 | MEDICAID | NORTH CAROLINA | |
| 15 | 1164683991 | MEDICAID | VIRGINIA | |
| 16 | VV6553A | MEDICARE PIN | VIRGINIA | |
