Healthcare Provider Details

I. General information

NPI: 1891026654
Provider Name (Legal Business Name): LOFTON VERNER ANDERSON LICENSED PROFESSIONA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2010
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 NORTH MAIN STREET
WOODSTOCK VA
22664
US

IV. Provider business mailing address

209 W. CRISER ROAD SUITE 300
FRONT ROYAL VA
22630
US

V. Phone/Fax

Practice location:
  • Phone: 540-459-5180
  • Fax: 540-459-4067
Mailing address:
  • Phone: 540-636-4250
  • Fax: 540-636-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004744
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: