Healthcare Provider Details

I. General information

NPI: 1386880888
Provider Name (Legal Business Name): KATHERINE WEAKS CRUMBLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5002 MONUMENT AVE
RICHMOND VA
23230-3634
US

IV. Provider business mailing address

5002 MONUMENT AVENUE
RICHMOND VA
23230
US

V. Phone/Fax

Practice location:
  • Phone: 804-497-4676
  • Fax:
Mailing address:
  • Phone: 804-201-7450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701005010
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: