Organization
NANCY MACCONNACHIE, PH.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANCY MACCONNACHIE PH.D. (PRESIDENT)
(804) 264-0966
Entity
Organization
Contact information
Practice address
5821 STAPLES MILL RD, RICHMOND, VA 23228-5427
(804) 264-0966
(804) 264-1029
Mailing address
5821 STAPLES MILL RD, RICHMOND, VA 23228-5427
(804) 264-0966
(804) 264-1029
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
00810001700
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007751338
—
VA
01
—
080290
SOUTHERN HEALTH/SENTARA
VA
01
—
177062
ANTHEM BCBS
VA
Enumeration date
05/18/2006
Last updated
06/21/2010
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