Healthcare Provider Details

I. General information

NPI: 1922903087
Provider Name (Legal Business Name): DAVID LEE HORTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 MARTIN ST
POUNDING MILL VA
24637-4169
US

IV. Provider business mailing address

268 MARTIN ST
POUNDING MILL VA
24637-4169
US

V. Phone/Fax

Practice location:
  • Phone: 276-873-2577
  • Fax:
Mailing address:
  • Phone: 276-873-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0704019524
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: