Healthcare Provider Details

I. General information

NPI: 1477296457
Provider Name (Legal Business Name): DOCTOR MAYS-COUCH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 04/18/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 THOMAS JEFFERESON HWY
CHARLOTTE COURTHOUSE VA
23923
US

IV. Provider business mailing address

PO BOX 32
FARMVILLE VA
23901-0032
US

V. Phone/Fax

Practice location:
  • Phone: 434-542-3315
  • Fax:
Mailing address:
  • Phone: 434-542-3315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY MAYS-COUCH
Title or Position: CEO
Credential: LCSW
Phone: 434-315-1817