Healthcare Provider Details

I. General information

NPI: 1578273611
Provider Name (Legal Business Name): CHALITA N THOMAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2022
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 HEATHCOTE VLG WAY SUITE 115 LIFESTANCE HEALTH
GAINESVILLE VA
20155
US

IV. Provider business mailing address

7051 HEATHCOTE VILLAGE WAY STE 115
GAINESVILLE VA
20155-3197
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax: 703-655-7686
Mailing address:
  • Phone: 804-207-6737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701011987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: