Healthcare Provider Details

I. General information

NPI: 1427240258
Provider Name (Legal Business Name): STEPHEN FLORA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 11/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

661 UNIVERSITY LN STE B
ORANGE VA
22960-2243
US

IV. Provider business mailing address

PO BOX 9007
CHARLOTTESVILLE VA
22906-9007
US

V. Phone/Fax

Practice location:
  • Phone: 540-661-3004
  • Fax: 540-661-3060
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: