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General NPI Number Information
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NPI Number | 1427246602
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Entity Type | Organization
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Legal Business Name | MARSHA MEAD, PHD, LPC, INC
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 10/12/2007
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Provider Practice Location Address
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Address Line | 105 WESTWOOD CMN
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City | BLUEFIELD
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State | VA
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Zip | 24605-2031
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Country | US
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Telephone | 276-971-5678
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | BLUEFIELD
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State | VA
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Zip | 24605-0250
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Country | US
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Telephone | 276-971-5678
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARSHA MEAD
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Credential | PHD
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Telephone | 276-971-5678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701001654
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License Number State | VA
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