Healthcare Provider Details

I. General information

NPI: 1649816521
Provider Name (Legal Business Name): WHITNEY O'BRIEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: WHITNEY HANEY

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 11/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 BYRD AVE
RICHMOND VA
23230-3033
US

IV. Provider business mailing address

1814 HIGHPOINT AVE APT 1417
RICHMOND VA
23230-4322
US

V. Phone/Fax

Practice location:
  • Phone: 804-592-6311
  • Fax:
Mailing address:
  • Phone: 703-973-6915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008529
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: