Healthcare Provider Details

I. General information

NPI: 1750405676
Provider Name (Legal Business Name): LARRY LEE SINSABAUGH PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: LARRY LEE SINSABAUGH LPC, LMFT

II. Dates (important events)

Enumeration Date: 03/17/2007
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 HERMITAGE RD SUITE 20
RICHMOND VA
23227-3332
US

IV. Provider business mailing address

4801 HERMITAGE RD STE 20
RICHMOND VA
23227-3332
US

V. Phone/Fax

Practice location:
  • Phone: 804-262-0571
  • Fax: 804-262-5937
Mailing address:
  • Phone: 804-262-0571
  • Fax: 804-262-5937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001735
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2104
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1377
License Number StateWV
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701-00000036
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0717-000060
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0715-000035
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number09-574058
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: