Healthcare Provider Details

I. General information

NPI: 1982181541
Provider Name (Legal Business Name): DENIS IBARRA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 BROOKLAND CT APT 5
WINCHESTER VA
22602-6258
US

IV. Provider business mailing address

55 BEATTIE PL STE 810
GREENVILLE SC
29601-2191
US

V. Phone/Fax

Practice location:
  • Phone: 305-915-2078
  • Fax:
Mailing address:
  • Phone: 864-527-3145
  • Fax: 864-990-0653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710103318
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: