Healthcare Provider Details

I. General information

NPI: 1669201695
Provider Name (Legal Business Name): MEGAN C INDERBITZEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 11/04/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLYMPIA CIR STE 101
CHARLOTTESVILLE VA
22911-3614
US

IV. Provider business mailing address

3173 HORIZON RD
CHARLOTTESVILLE VA
22902-6605
US

V. Phone/Fax

Practice location:
  • Phone: 434-202-4080
  • Fax:
Mailing address:
  • Phone: 724-605-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704014746
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: