MEDICARE: LAURA BETH OLLIFF MAPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1609334275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BETH OLLIFF MAPC

Provider Business Mailing Address
First Line	:	12930 CRESCENT GRN APT 305
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23114-5573
Country	:	US
Telephone Number	:	912-856-6964
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 WYNDHAM LAKE DR STE B
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7072
Country	:	US
Telephone Number	:	804-592-2793
Fax Number	:	804-592-2794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2019
Last Update Date	:	03/03/2019

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Directions to “ LAURA BETH OLLIFF MAPC” Practice Location

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