Provider Demographics
NPI:1104067495
Name:ARTS FOR REPLENISHMENT AND CHANGE, PLLC
Entity type:Organization
Organization Name:ARTS FOR REPLENISHMENT AND CHANGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE (ANNIE)
Authorized Official - Middle Name:READY
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:804-305-2295
Mailing Address - Street 1:530 E MAIN ST STE 420
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-2431
Mailing Address - Country:US
Mailing Address - Phone:804-305-2295
Mailing Address - Fax:804-525-5656
Practice Address - Street 1:530 E MAIN ST STE 420
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-2431
Practice Address - Country:US
Practice Address - Phone:804-305-2295
Practice Address - Fax:804-525-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002538103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
089494OtherOPTIMA HEALTH
11617310OtherCAQH
61-90123OtherOPTIMUM CHOICE
089494OtherSENTARA
VA010324122Medicaid
VA1255361200OtherNPI
61-90123OtherUBH