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Organization
KETAMINE RVA
Active
Organization
KETAMINE RVA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON FREDERICK (OWNER)
(804) 993-3039
Entity
Organization
Contact information
Practice address
8639 MAYLAND DR STE 102, HENRICO, VA 23294-4752
(804) 993-3039
Mailing address
8639 MAYLAND DR STE 102, HENRICO, VA 23294-4752
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/25/2024
Last updated
10/25/2024
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