Basic Information
| Provider Information | |||||||||
| NPI: | 1972591071 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARCLAY | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | H. | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1047 VISTA PARK DR. STE A | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245512283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346162388 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1047 VISTA PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | FOREST | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245514362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4346162388 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 01/11/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TA0400X | Y | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TB0200X | N | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | 103TC0700X | 0810004569 | VA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC1900X | N | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.