Organization
PSYCHOLOGICAL CENTER PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J SHEA PHD (OWNER PRESIDENT)
(757) 490-3880
Entity
Organization
Contact information
Practice address
505 S INDEPENDENCE BLVD, SUITE 207, VIRGINIA BEACH, VA 23452-1150
(757) 490-3880
(757) 497-4197
Mailing address
PO BOX 2038, VIRGINIA BEACH, VA 23450-2038
(757) 490-3880
(757) 497-4197
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
277036000
MAGELLAN BEHAV
—
01
—
344452
MANAGED HLTH NTWK
—
01
—
4490925
AETNA
—
Enumeration date
12/19/2006
Last updated
12/07/2010
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