Provider Demographics
NPI:1104067149
Name:PENDLETON, CHRISTEN (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHRISTEN
Middle Name:
Last Name:PENDLETON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8189
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-0189
Mailing Address - Country:US
Mailing Address - Phone:646-736-2002
Mailing Address - Fax:
Practice Address - Street 1:2400 OLD BRICK RD STE 51
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-5841
Practice Address - Country:US
Practice Address - Phone:646-736-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-22
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021540-1103TC0700X
VA0810005763103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical