Healthcare Provider Details

I. General information

NPI: 1255878880
Provider Name (Legal Business Name): DEVONA TALLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N 2ND ST
RICHMOND VA
23219-1359
US

IV. Provider business mailing address

PO BOX 780125
PHILADELPHIA PA
19178-0125
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-6777
  • Fax: 804-628-6768
Mailing address:
  • Phone: 804-922-4844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006712
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: