Healthcare Provider Details

I. General information

NPI: 1215796776
Provider Name (Legal Business Name): VICKY PENNINGTON-CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GARDNERS RD
CROSS JUNCTION VA
22625-2229
US

IV. Provider business mailing address

300 GARDNERS RD
CROSS JUNCTION VA
22625-2229
US

V. Phone/Fax

Practice location:
  • Phone: 540-550-1670
  • Fax:
Mailing address:
  • Phone: 540-550-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: