Healthcare Provider Details

I. General information

NPI: 1336928506
Provider Name (Legal Business Name): LARY CAROLINA SEGOVIA CHAVEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 TECH CENTER PKWY STE 200-43
NEWPORT NEWS VA
23606-3075
US

IV. Provider business mailing address

3 MEADOW DR
NEWPORT NEWS VA
23606-2800
US

V. Phone/Fax

Practice location:
  • Phone: 619-602-5252
  • Fax:
Mailing address:
  • Phone: 619-602-5252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701010093
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701010093
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: