Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist |
NPI | 1083139562 |
---|---|
Provider Name | Christina Vitek |
First Address | Henrico, VA 23229-3946 |
Second Address | Henrico, VA 23229-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2017 |
Last Update Date | 07/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0813000414 | COMMONWEALTH OF VIRGINIA BOARD OF PSYCHOLOGY (01) | VA |