=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235473117
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN MARIE OVERMAN LPC, ATR, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2012
-----------------------------------------------------
Last Update Date | 05/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 707 GITTINGS ST #120
-----------------------------------------------------
City | SUFFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23434-6101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-514-3248
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10413 SYLVIA CIR
-----------------------------------------------------
City | WINDSOR
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23487-5368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-638-2814
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------