Provider Demographics
NPI:1194109371
Name:COUNSELING & DIAGNOSTIC SERVICES
Entity type:Organization
Organization Name:COUNSELING & DIAGNOSTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BRAEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:804-840-6184
Mailing Address - Street 1:10216 PEPPERHILL LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3835
Mailing Address - Country:US
Mailing Address - Phone:804-840-6184
Mailing Address - Fax:804-592-2667
Practice Address - Street 1:13801 VILLAGE MILL DR STE 105
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4382
Practice Address - Country:US
Practice Address - Phone:804-840-6184
Practice Address - Fax:804-592-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002140103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty