Healthcare Provider Details

I. General information

NPI: 1730729096
Provider Name (Legal Business Name): MARY TABITHA VARNEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/14/2020
Certification Date: 01/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BUFORD RD. UNIT 110
NORTH CHESTERFIELD VA
23235
US

IV. Provider business mailing address

7613 GENUINE RISK LN.
MIDLOTHIAN VA
23112
US

V. Phone/Fax

Practice location:
  • Phone: 804-447-6382
  • Fax:
Mailing address:
  • Phone: 540-521-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008853
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: