Ganderson, Stephen Carl
Ganderson, Stephen Carl is an sole proprietor health care provider with primary practice located at 505 Cedar Rd Suite B-1, Chesapeake VA 23322-5585. He recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as his primary health care specialty. Ganderson, Stephen Carl can be contacted via phone (757) 548-9996.Contact Information
Primary practice address
505 Cedar Rd Suite B-1
Chesapeake VA 23322-5585
Phone: (757) 548-9996
Fax: (757) 382-5085
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | 0810001638 | Virginia |
Profile Details
| NPI number | 1902994262 |
|---|---|
| LBN Legal business name | Ganderson, Stephen Carl |
| Credentials | PSY.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 11th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1902994262 | NPPES |
| Virginia | MEDICAID | 7704755 |
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