Healthcare Provider Details

I. General information

NPI: 1659266260
Provider Name (Legal Business Name): EMMA LEA MASON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 FOUR LEAF LN STE 12
CHARLOTTESVILLE VA
22903-9203
US

IV. Provider business mailing address

325 FOUR LEAF LN STE 12
CHARLOTTESVILLE VA
22903-9203
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-4080
  • Fax: 844-705-0170
Mailing address:
  • Phone: 804-894-5285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: