Healthcare Provider Details

I. General information

NPI: 1164969408
Provider Name (Legal Business Name): YESENIA ADENT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W BANK ST SUITE 3
PETERSBURG VA
23803-3279
US

IV. Provider business mailing address

13600 LAKETREE DR
CHESTER VA
23831-5220
US

V. Phone/Fax

Practice location:
  • Phone: 804-722-4299
  • Fax: 804-722-4283
Mailing address:
  • Phone: 804-243-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701006927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: