# CRATER CHILD DEVELOPMENT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164468823
- **Authorized official:** DR. MICHAEL OWEN ROYSTER MD (DISTRICT HEALTH DIRECTOR)
- **Authorized official phone:** (804) 863-1663

## Contact information

- **Practice address:** 2002 WAKEFIELD STREET, PETERSBURG, VA 23805-2112
- **Practice address phone:** (804) 862-6186
- **Practice address fax:** (804) 862-6276
- **Mailing address:** 2002 WAKEFIELD AVE, PETERSBURG, VA 23805-2112
- **Mailing address phone:** (804) 862-6186
- **Mailing address fax:** (804) 862-6276

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | — | VA | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 08/22/2020