Healthcare Provider Details

I. General information

NPI: 1952117244
Provider Name (Legal Business Name): AVIVAH KNOWLES LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18447 BUZZARD HOLLOW RD
GORDONSVILLE VA
22942-7605
US

IV. Provider business mailing address

18447 BUZZARD HOLLOW RD
GORDONSVILLE VA
22942-7605
US

V. Phone/Fax

Practice location:
  • Phone: 540-859-9212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701014296
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: