NPIMap

Organization Active NPI

Centra Health Professional Services, LLC

Doing business as Child/Adolescent Psych Program

  • Child & Adolescent Psychiatry Physician
  • Lynchburg, VA
National Provider Identifier
1235480351
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
Legal business name
CENTRA HEALTH PROFESSIONAL SERVICES, LLC
Doing business as
Child/Adolescent Psych Program
Practice address
3300 Rivermont Ave
Lynchburg, VA 24503-2030
Phone
(434) 200-5999
NPI assigned
Sep 28, 2012
Last updated
Sep 28, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
CENTRA HEALTH PROFESSIONAL SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lewis Addison
Title
Cfo
Phone
(434) 200-3656

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X NU Primary

Addresses

Primary practice location

3300 Rivermont Ave
Lynchburg, VA 24503-2030

Mailing address

1204 Fenwick Dr
Lynchburg, VA 24502-2112

Other names 1

  • Child/Adolescent Psych Program Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Centra Health Professional Services106 organizations share this tax ID, including this one
Part of
Centra Health Professional Services

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1235480351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 FENWICK DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245022112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 RIVERMONT AVE",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245032030",
            "telephone_number": "434-200-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA HEALTH PROFESSIONAL SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA HEALTH PROFESSIONAL SERVICES, LLC",
        "enumeration_date": "2012-09-28",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "ADDISON",
        "authorized_official_first_name": "LEWIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "434-200-3656"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Child/Adolescent Psych Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynchburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.