MEDICARE: SYLVIA AMY FUNN LPC

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	101YP2500X	Professional Counselor	0701011077	VA

General Provider Information

NPI Number	:	1669125209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLVIA AMY FUNN LPC

Provider Business Mailing Address
First Line	:	4532 FORDHAM RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1122
Country	:	US
Telephone Number	:	804-382-1519
Fax Number	:

Provider Business Practice Location Address
First Line	:	4532 FORDHAM RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1122
Country	:	US
Telephone Number	:	804-382-1519
Fax Number	:

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

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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