MEDICARE: MS. SYLVIA L PEGRAM

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		VA
2	101Y00000X	Counselor		VA

General Provider Information

NPI Number	:	1952815698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SYLVIA L PEGRAM

Provider Business Mailing Address
First Line	:	7825 MIDLOTHIAN TURNPIKE
Second Line	:	SUITE 203
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235
Country	:	US
Telephone Number	:	229-412-8125
Fax Number	:	804-621-2292

Provider Business Practice Location Address
First Line	:	7825 MIDLOTHIAN TPKE STE 203
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5247
Country	:	US
Telephone Number	:	229-412-8125
Fax Number	:

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

Provider Enumeration Date	:	11/16/2017
Last Update Date	:	11/16/2017

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