Healthcare Provider Details

I. General information

NPI: 1598758773
Provider Name (Legal Business Name): JAMES FREDRICK BEBEAU LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 HAIRSTON ST
DANVILLE VA
24540-4137
US

IV. Provider business mailing address

245 HAIRSTON ST
DANVILLE VA
24540-4137
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-0456
  • Fax: 434-793-4201
Mailing address:
  • Phone: 434-799-0456
  • Fax: 434-793-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003319
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: