Healthcare Provider Details

I. General information

NPI: 1659602910
Provider Name (Legal Business Name): TIMOTHY RAMBO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2010
Last Update Date: 01/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ARLINGTON BLVD
CHARLOTTESVILLE VA
22903-1521
US

IV. Provider business mailing address

2101 ARLINGTON BLVD
CHARLOTTESVILLE VA
22903-1521
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-4515
  • Fax: 330-758-2862
Mailing address:
  • Phone: 330-758-4515
  • Fax: 330-758-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004627
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: