MEDICARE: JOHN PAUL FRETHEIM LCSW

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	101Y00000X	Counselor	0904000312	VA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0904000312	VA
3	101YM0800X	Mental Health Counselor	0904000312	VA
4	106H00000X	Marriage & Family Therapist	0904000312	VA

General Provider Information

NPI Number	:	1629034046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN PAUL FRETHEIM LCSW

Provider Business Mailing Address
First Line	:	510 S SYCAMORE ST
Second Line	:	SUITE F
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5044
Country	:	US
Telephone Number	:	804-861-0700
Fax Number	:	804-863-4626

Provider Business Practice Location Address
First Line	:	510 S SYCAMORE ST
Second Line	:	SUITE F
City	:	PETERSBURG
State	:	VA
Zip	:	23803-5044
Country	:	US
Telephone Number	:	804-861-0700
Fax Number	:	804-863-4626

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	09/11/2025

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