=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205242880
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK LOEWEN LPC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2014
-----------------------------------------------------
Last Update Date | 12/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5540 FALMOUTH ST SUITE 100
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-665-4681
-----------------------------------------------------
Fax | 888-379-2724
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5540 FALMOUTH ST SUITE 100
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-1800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-665-4681
-----------------------------------------------------
Fax | 888-379-2724
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MARK RICHARD WALDE LOEWEN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 804-665-4681
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 0701004844
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------