Healthcare Provider Details

I. General information

NPI: 1447925532
Provider Name (Legal Business Name): AVIGYIL BUEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 08/11/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 BROOK PARK PL
FOREST VA
24551-2766
US

IV. Provider business mailing address

1307 HOMESTEAD GARDEN CT APT 4
FOREST VA
24551-1474
US

V. Phone/Fax

Practice location:
  • Phone: 434-533-1088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010622
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: