Healthcare Provider Details

I. General information

NPI: 1497352645
Provider Name (Legal Business Name): VICTOR M RIVERA SINK MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FERRUM MOUNTAIN RD
FERRUM VA
24088-2939
US

IV. Provider business mailing address

PO BOX 519
FERRUM VA
24088-0519
US

V. Phone/Fax

Practice location:
  • Phone: 540-365-4469
  • Fax: 540-365-4272
Mailing address:
  • Phone: 540-365-4469
  • Fax: 540-365-4272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701009947
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: