Healthcare Provider Details

I. General information

NPI: 1700374345
Provider Name (Legal Business Name): DANA N REXRODE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 COMMONWEALTH DR STE 100
CHARLOTTESVILLE VA
22901-1634
US

IV. Provider business mailing address

5771 HEARDS MOUNTAIN RD
COVESVILLE VA
22931-1639
US

V. Phone/Fax

Practice location:
  • Phone: 434-326-1200
  • Fax:
Mailing address:
  • Phone: 434-806-7707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: