Healthcare Provider Details

I. General information

NPI: 1902726441
Provider Name (Legal Business Name): AUTUMN DUFFY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 BULIFANTS BLVD STE C
WILLIAMSBURG VA
23188-5719
US

IV. Provider business mailing address

113 BULIFANTS BLVD STE C
WILLIAMSBURG VA
23188-5719
US

V. Phone/Fax

Practice location:
  • Phone: 757-707-8146
  • Fax: 888-388-0907
Mailing address:
  • Phone: 757-707-8146
  • Fax: 888-388-0907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701016270
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: