Healthcare Provider Details

I. General information

NPI: 1346802410
Provider Name (Legal Business Name): STEPHEN C. COMBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2126 JEFFERSON DAVIS HWY STE 103
STAFFORD VA
22554-7294
US

IV. Provider business mailing address

11205 CARRIAGE HOUSE CT
FREDERICKSBURG VA
22408-2449
US

V. Phone/Fax

Practice location:
  • Phone: 404-291-5330
  • Fax: 540-658-0855
Mailing address:
  • Phone: 540-710-7755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701008403
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: