Healthcare Provider Details

I. General information

NPI: 1114579760
Provider Name (Legal Business Name): JOE WAREING LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2019
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1932 LAUREL CREEK RD NE
PILOT VA
24138-1554
US

IV. Provider business mailing address

1932 LAUREL CREEK RD NE
PILOT VA
24138-1554
US

V. Phone/Fax

Practice location:
  • Phone: 540-988-3768
  • Fax: 540-305-3713
Mailing address:
  • Phone: 540-988-3768
  • Fax: 540-305-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701007949
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: