Healthcare Provider Details

I. General information

NPI: 1588678098
Provider Name (Legal Business Name): ANGELA POYTHRESS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELA M. POYTHRESS LPC

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 MADISON ST.
BOYDTON VA
23917
US

IV. Provider business mailing address

PO BOX 1478
CLARKSVILLE VA
23927-1478
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-0154
  • Fax: 434-572-4881
Mailing address:
  • Phone: 434-572-6916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701002935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: