Healthcare Provider Details

I. General information

NPI: 1265570501
Provider Name (Legal Business Name): DENISE M BUMGARNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 PRINCESS ANNE ST STE 327
FREDERICKSBURG VA
22401-3353
US

IV. Provider business mailing address

12 BURNS RD
STAFFORD VA
22554-7651
US

V. Phone/Fax

Practice location:
  • Phone: 540-737-8120
  • Fax: 540-322-2002
Mailing address:
  • Phone: 540-658-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number07010001829
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: