# CENTRA MEDICAL GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRA MEDICAL GROUP, LLC
- **Other names:** Autism Diagnostic Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609818293
- **Legal business name:** CENTRA MEDICAL GROUP, LLC
- **Authorized official:** LEWIS ADDISON (SR VP CFO)
- **Authorized official phone:** (434) 200-5047

## Contact information

- **Practice address:** 693 LEESVILLE RD, LYNCHBURG, VA 24502-2828
- **Practice address phone:** (434) 200-5700
- **Mailing address:** 2010 ATHERHOLT RD, LYNCHBURG, VA 24501-1106

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | Yes |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/11/2006
- **Last updated:** 01/15/2014