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General NPI Number Information
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NPI Number | 1235103367
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Entity Type | Individual
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Provider Name | MARY KAY ROSE LPC
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Gender | Female
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Dates
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Enumeration Date | 02/15/2006
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 600 LEE HWY
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City | VERONA
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State | VA
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Zip | 24482-2501
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Country | US
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Telephone | 540-290-3144
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Fax |
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Provider Business Mailing Address
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Address Line | 3895 SHUTTERLEE MILL RD
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City | STAUNTON
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State | VA
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Zip | 24401-6312
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Country | US
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Telephone | 540-290-3144
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Fax | 408-886-0138
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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 | PRC2000002
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003775
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License Number State | VA
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