MEDICARE: STRATEGIC THERAPY ASSOCIATES, INC.

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
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	014-03-001	OTHER	VA	VIRGINIA BOARD OF LICENSING
2	014-05-001	OTHER	VA	VIRGINIA BOARD OF LICENSING

General Provider Information

NPI Number	:	1912496340
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STRATEGIC THERAPY ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	108 DUNCRAIG DR
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-3335
Country	:	US
Telephone Number	:	434-473-6955
Fax Number	:	434-237-9454

Provider Business Practice Location Address
First Line	:	6 WALL ST
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-2700
Country	:	US
Telephone Number	:	276-258-6707
Fax Number	:	434-237-9454

Authorized Official
Title or Position	:	QUALITY ASSURANCE DIRECTOR
Name	:	STEPHANIE NICOLE JOHNSON
Credential	:
Telephone Number	:	434-473-6955

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	04/24/2025

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