Healthcare Provider Details

I. General information

NPI: 1033808621
Provider Name (Legal Business Name): MICHAEL OSBORNE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2023
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

469 MCLAWS CIR
WILLIAMSBURG VA
23185-5645
US

IV. Provider business mailing address

324 MONTICELLO AVE
WILLIAMSBURG VA
23185-2834
US

V. Phone/Fax

Practice location:
  • Phone: 757-503-7917
  • Fax: 855-823-3243
Mailing address:
  • Phone: 757-503-7917
  • Fax: 855-823-3243

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: