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General NPI Number Information
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NPI Number | 1285539304
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Entity Type | Individual
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Provider Name | BRIAN SANTIAGO GUZMAN
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Gender | Male
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Dates
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Enumeration Date | 10/09/2026
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Last Update Date | 10/09/2026
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Provider Practice Location Address
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Address Line | 1047 VISTA PARK DR STE A
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City | FOREST
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State | VA
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Zip | 24551-4362
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Country | US
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Telephone | 434-382-1123
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3351
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City | LYNCHBURG
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State | VA
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Zip | 24503-0351
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Country | US
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Telephone | 434-509-6407
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0704018800
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License Number State | VA
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