Individual
WAVERLY DANDRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3106 MOUNTAIN RD, GLEN ALLEN, VA 23060-2015
(804) 240-6252
(804) 562-4411
Mailing address
3106 MOUNTAIN RD, GLEN ALLEN, VA 23060-2015
(804) 240-6252
(804) 562-4411
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0167851648
API
VA
Enumeration date
08/27/2015
Last updated
08/27/2015
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