Provider Demographics
NPI:1992062830
Name:MASON, MICHAEL J (PHD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:MASON
Suffix:
Gender:M
Credentials:PHD
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 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23298-0510
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:515 N 10TH ST
Practice Address - Street 2:VIRGINIA TREATMENT CENTER FOR CHILDREN
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5040
Practice Address - Country:US
Practice Address - Phone:804-828-3129
Practice Address - Fax:804-282-7814
Is Sole Proprietor?:No
Enumeration Date:2012-04-17
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005207101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional