Healthcare Provider Details

I. General information

NPI: 1972100881
Provider Name (Legal Business Name): ARI LAOCH LPC, CRC, CBIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2020
Last Update Date: 10/04/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 GARY AVE
CHESTER VA
23831-7406
US

IV. Provider business mailing address

16111 GARY AVE
CHESTER VA
23831-7406
US

V. Phone/Fax

Practice location:
  • Phone: 804-496-1556
  • Fax:
Mailing address:
  • Phone: 804-855-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701008540
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: