Healthcare Provider Details

I. General information

NPI: 1811292154
Provider Name (Legal Business Name): JUDITH WAMBUI PRESTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 GREENBRIER CIR STE 209
CHESAPEAKE VA
23320-2642
US

IV. Provider business mailing address

224 GREAT BRIDGE BLVD
CHESAPEAKE VA
23320-3904
US

V. Phone/Fax

Practice location:
  • Phone: 757-818-5905
  • Fax: 757-319-4347
Mailing address:
  • Phone: 757-547-9334
  • Fax: 757-819-6292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701004803
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: