1912496340 NPI number — STRATEGIC THERAPY ASSOCIATES, INC.

Table of content: (NPI 1912496340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912496340 NPI number — STRATEGIC THERAPY ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRATEGIC THERAPY ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912496340
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 DUNCRAIG DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24502-3335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-473-6955
Provider Business Mailing Address Fax Number:
434-237-9454

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 WALL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARTINSVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24112-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-258-6707
Provider Business Practice Location Address Fax Number:
434-237-9454
Provider Enumeration Date:
05/01/2018

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
QUALITY ASSURANCE DIRECTOR
Authorized Official Telephone Number:
434-473-6955

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 014-03-001 . This is a "VIRGINIA BOARD OF LICENSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 014-05-001 . This is a "VIRGINIA BOARD OF LICENSING" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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