Healthcare Provider Details

I. General information

NPI: 1740052257
Provider Name (Legal Business Name): AGATA AGNIESZKA DUPONT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 LAKE MONTICELLO RD
PALMYRA VA
22963-4254
US

IV. Provider business mailing address

2704 LAKE MONTICELLO RD
PALMYRA VA
22963-4254
US

V. Phone/Fax

Practice location:
  • Phone: 434-207-2554
  • Fax: 434-285-0420
Mailing address:
  • Phone: 434-207-2554
  • Fax: 434-285-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0704015014
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701014459
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: