Healthcare Provider Details

I. General information

NPI: 1639798929
Provider Name (Legal Business Name): SEAN PATRICK HURLEY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 04/16/2020
Certification Date: 04/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 TANBARK PLZ
LOVINGSTON VA
22949-2464
US

IV. Provider business mailing address

PO BOX 417
LOVINGSTON VA
22949-0417
US

V. Phone/Fax

Practice location:
  • Phone: 434-989-2312
  • Fax:
Mailing address:
  • Phone: 434-989-2312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009057
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: