Provider Demographics
NPI:1487884102
Name:CHESAPEAKE PSYCHOLOGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:CHESAPEAKE PSYCHOLOGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RHOAD
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:757-749-7809
Mailing Address - Street 1:1435 CROSSWAYS BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2896
Mailing Address - Country:US
Mailing Address - Phone:757-410-0072
Mailing Address - Fax:
Practice Address - Street 1:1435 CROSSWAYS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2896
Practice Address - Country:US
Practice Address - Phone:757-410-0072
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002751103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty