Healthcare Provider Details

I. General information

NPI: 1386269256
Provider Name (Legal Business Name): MARIANNE STINSON, LPC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1553 BRADFORD RD STE 102
VIRGINIA BEACH VA
23455-4094
US

IV. Provider business mailing address

PO BOX 64552
VIRGINIA BEACH VA
23467-4552
US

V. Phone/Fax

Practice location:
  • Phone: 757-453-2144
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIANNE STINSON
Title or Position: SOLE MEMBER
Credential: LPC
Phone: 757-945-1388