Healthcare Provider Details

I. General information

NPI: 1679810485
Provider Name (Legal Business Name): VIRGINIA YAUCHZY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2013
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 PATHFINDER WAY SUITE NUMBER 130
ROCKLEDGE FL
32955-3242
US

IV. Provider business mailing address

45 LITTLEJOHN LN
ROCKLEDGE FL
32955-2410
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-1224
  • Fax:
Mailing address:
  • Phone: 717-634-8656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7833
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: