Healthcare Provider Details

I. General information

NPI: 1235567884
Provider Name (Legal Business Name): JANE MARIE FETTERMAN L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 GENERAL DR STE 300
LURAY VA
22835-5263
US

IV. Provider business mailing address

PO BOX 63
LINVILLE VA
22834-0063
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-4548
  • Fax: 540-743-6067
Mailing address:
  • Phone: 540-820-9886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: