Healthcare Provider Details

I. General information

NPI: 1811863798
Provider Name (Legal Business Name): AVA MICHELE PUGLIESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5198 T C WALKER RD
GLOUCESTER VA
23061-4466
US

IV. Provider business mailing address

5198 T C WALKER RD
GLOUCESTER VA
23061-4466
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-2540
  • Fax: 804-824-9608
Mailing address:
  • Phone: 804-693-2540
  • Fax: 804-824-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberPROV-0660782
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: