Healthcare Provider Details

I. General information

NPI: 1083562607
Provider Name (Legal Business Name): RAVYN JOLEA MONGOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 NEFF AVE
HARRISONBURG VA
22801-3429
US

IV. Provider business mailing address

338 NEFF AVE
HARRISONBURG VA
22801-3429
US

V. Phone/Fax

Practice location:
  • Phone: 540-578-3691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number701016413
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: