Healthcare Provider Details

I. General information

NPI: 1417960857
Provider Name (Legal Business Name): JOSEPH F O'BRIEN JR. LPC, LSATP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12829 JEFFERSON AVE STE 101
NEWPORT NEWS VA
23608-3057
US

IV. Provider business mailing address

5361A VIRGINIA BEACH BLVD
VIRGINIA BEACH VA
23462-1897
US

V. Phone/Fax

Practice location:
  • Phone: 757-875-0060
  • Fax: 757-877-7883
Mailing address:
  • Phone: 757-456-2366
  • Fax: 757-321-6269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0718000069
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701002875
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: