Healthcare Provider Details

I. General information

NPI: 1851523187
Provider Name (Legal Business Name): JONI SUE HURSEY-WINGATE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4310 INDIAN RIVER RD SUITE 4
CHESAPEAKE VA
23325-3100
US

IV. Provider business mailing address

1341 WHITE MARLIN LN
VIRGINIA BEACH VA
23464-6342
US

V. Phone/Fax

Practice location:
  • Phone: 757-963-6563
  • Fax:
Mailing address:
  • Phone: 757-773-9511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004622
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: