Healthcare Provider Details

I. General information

NPI: 1790340156
Provider Name (Legal Business Name): WYTHE COUNSELING ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2019
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 E MAIN ST STE A
WYTHEVILLE VA
24382-2302
US

IV. Provider business mailing address

170 NOTTINGHAM DR
WYTHEVILLE VA
24382-1412
US

V. Phone/Fax

Practice location:
  • Phone: 276-613-4273
  • Fax:
Mailing address:
  • Phone: 276-613-4273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MINNA LINDAMOOD
Title or Position: OWNER/PROPRIETOR
Credential: LPC
Phone: 276-613-4273