Healthcare Provider Details

I. General information

NPI: 1093020489
Provider Name (Legal Business Name): WILLIAMSBURG COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 STRAWBERRY PLAINS RD
WILLIAMSBURG VA
23188-3442
US

IV. Provider business mailing address

286 E QUEENS DR
WILLIAMSBURG VA
23185-5042
US

V. Phone/Fax

Practice location:
  • Phone: 757-903-2406
  • Fax:
Mailing address:
  • Phone: 757-903-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0717001251
License Number StateVA

VIII. Authorized Official

Name: AMANDA DEVERICH
Title or Position: THERAPIST
Credential: LMFT, MED, NCC
Phone: 757-903-2406