Healthcare Provider Details

I. General information

NPI: 1598418451
Provider Name (Legal Business Name): KATHERINE ANN GWALTNEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2022
Last Update Date: 02/01/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 PARK ST
CHARLOTTESVILLE VA
22902-4739
US

IV. Provider business mailing address

612 14TH ST
WAYNESBORO VA
22980-4802
US

V. Phone/Fax

Practice location:
  • Phone: 434-321-8611
  • Fax:
Mailing address:
  • Phone: 540-797-1445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011093
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: