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Organization

CENTRA MEDICAL GROUP, LLC

Active
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Organization

CENTRA MEDICAL GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. JOSHUA LARKIN (CREDENTIALING SPECIALIST)
(434) 200-5047
Entity
Organization

Contact information

Practice address
2010 ATHERHOLT RD, LYNCHBURG, VA 24501-1106
(434) 200-5047
Mailing address
2010 ATHERHOLT RD, LYNCHBURG, VA 24501-1106
(434) 200-5047

Taxonomy

Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
NULL
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—

Other

Enumeration date
04/21/2016
Last updated
04/21/2016
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