Healthcare Provider Details

I. General information

NPI: 1265557763
Provider Name (Legal Business Name): GEORGE HAROLD ENFIELD LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 04/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 FAULCONER DR 2D
CHARLOTTESVILLE VA
22903-4980
US

IV. Provider business mailing address

386 JOLIET CT
CROZET VA
22932-9305
US

V. Phone/Fax

Practice location:
  • Phone: 434-963-0324
  • Fax: 434-971-5625
Mailing address:
  • Phone: 434-906-0449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE4312
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005107
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: