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General NPI Number Information
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NPI Number | 1346786852
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Entity Type | Organization
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Legal Business Name | CENTRAL VIRGINIA COUNSELING PLLC
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 09/23/2022
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Provider Practice Location Address
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Address Line | 808 WIGGINGTON RD STE D
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City | LYNCHBURG
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State | VA
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Zip | 24502-5155
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Country | US
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Telephone | 434-473-2291
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Fax | 540-765-3369
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Provider Business Mailing Address
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Address Line | 808 WIGGINGTON RD STE D
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City | LYNCHBURG
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State | VA
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Zip | 24502-5155
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Country | US
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Telephone | 434-473-2291
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. GRACE ELLEN PETTY
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Credential | M.A., L.P.C.
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Telephone | 434-473-2291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701005872
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License Number State | VA
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