=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295303766
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STRENGTH & EASE PSYCHOTHERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2021
-----------------------------------------------------
Last Update Date | 06/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 77 KATHYS LN
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22974-4489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-760-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 77 KATHYS LN
-----------------------------------------------------
City | TROY
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22974-4489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-760-4321
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | REBECCA TEDFORD
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 434-218-2634
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------