=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396380762
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEANA WEEMS LPC, NCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2019
-----------------------------------------------------
Last Update Date | 09/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17220 DAWN CT
-----------------------------------------------------
City | AMELIA COURT HOUSE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23002-4891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-433-9323
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17220 DAWN CT
-----------------------------------------------------
City | AMELIA COURT HOUSE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23002-4891
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-433-9323
-----------------------------------------------------
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 | 2357
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0701008984
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------