Healthcare Provider Details

I. General information

NPI: 1417010356
Provider Name (Legal Business Name): BETHANY PEARL BRINTLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14558 DANVILLE PIKE
LAUREL FORK VA
24352-3982
US

IV. Provider business mailing address

106 FAIRLAKE LN
LAUREL FORK VA
24352-3987
US

V. Phone/Fax

Practice location:
  • Phone: 276-398-2292
  • Fax: 276-398-3331
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005133
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4307
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: