Healthcare Provider Details

I. General information

NPI: 1952815698
Provider Name (Legal Business Name): MS. SYLVIA L PEGRAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2017
Last Update Date: 11/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 MIDLOTHIAN TPKE STE 203
NORTH CHESTERFIELD VA
23235-5247
US

IV. Provider business mailing address

7825 MIDLOTHIAN TURNPIKE SUITE 203
NORTH CHESTERFIELD VA
23235
US

V. Phone/Fax

Practice location:
  • Phone: 229-412-8125
  • Fax:
Mailing address:
  • Phone: 229-412-8125
  • Fax: 804-621-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: