Healthcare Provider Details

I. General information

NPI: 1720337405
Provider Name (Legal Business Name): RAFALA PROFESSIONAL COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 SOUTHRIDGE PKWY SUITE 301B
CULPEPER VA
22701-3723
US

IV. Provider business mailing address

700 SOUTHRIDGE PKWY SUITE 301B
CULPEPER VA
22701-3723
US

V. Phone/Fax

Practice location:
  • Phone: 540-829-0036
  • Fax: 540-829-6452
Mailing address:
  • Phone: 540-829-0036
  • Fax: 540-829-6452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN LANHAM
Title or Position: OFFICE MANAGER
Credential:
Phone: 540-829-0036