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General NPI Number Information
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NPI Number | 1023819562
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Entity Type | Individual
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Provider Name | MIESHA PENN LPC
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Gender | Female
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Dates
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Enumeration Date | 03/21/2025
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 32 BRIDGE ST S
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City | MARTINSVILLE
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State | VA
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Zip | 24112-6216
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Country | US
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Telephone | 276-336-3336
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Fax |
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Provider Business Mailing Address
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Address Line | 607 MULBERRY RD
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City | MARTINSVILLE
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State | VA
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Zip | 24112-3916
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Country | US
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Telephone | 276-806-6951
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701014665
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License Number State | VA
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