Healthcare Provider Details

I. General information

NPI: 1275111247
Provider Name (Legal Business Name): DUSTIN SARRGE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 COURT ST
LYNCHBURG VA
24504-1312
US

IV. Provider business mailing address

618 COURT ST
LYNCHBURG VA
24504-1312
US

V. Phone/Fax

Practice location:
  • Phone: 434-847-8035
  • Fax:
Mailing address:
  • Phone: 434-485-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010338
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: