=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144364373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VALLEY PASTORAL COUNSELING CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/19/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 CHESTNUT AVE
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22980-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-943-8722
-----------------------------------------------------
Fax | 540-943-5068
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 CHESTNUT AVE
-----------------------------------------------------
City | WAYNESBORO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22980-4702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-943-8722
-----------------------------------------------------
Fax | 540-943-5068
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | DR. KRISTEN DAVIDSON
-----------------------------------------------------
Credential | ED.D, LPC
-----------------------------------------------------
Telephone | 540-943-8722
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701003917
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------