Healthcare Provider Details

I. General information

NPI: 1881392652
Provider Name (Legal Business Name): MOUNTAIN CREEK COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2023
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 OLD BUENA VISTA RD
LEXINGTON VA
24450-3736
US

IV. Provider business mailing address

PO BOX 338
LEXINGTON VA
24450-0338
US

V. Phone/Fax

Practice location:
  • Phone: 540-742-7260
  • Fax:
Mailing address:
  • Phone: 540-742-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SUSAN E BEDELL
Title or Position: COUNSELOR
Credential: LCSW
Phone: 540-742-7260