Healthcare Provider Details

I. General information

NPI: 1063691186
Provider Name (Legal Business Name): CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 E MARKET ST
HARRISONBURG VA
22801-4241
US

IV. Provider business mailing address

911 E JEFFERSON ST
CHARLOTTESVILLE VA
22902-5355
US

V. Phone/Fax

Practice location:
  • Phone: 540-437-1605
  • Fax: 540-437-1606
Mailing address:
  • Phone: 434-984-0023
  • Fax: 434-984-4852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JULIE WALLS
Title or Position: SITE DIRECTOR
Credential: LCSW
Phone: 540-437-1605