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General NPI Number Information
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NPI Number | 1508565797
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Entity Type | Individual
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Provider Name | THEODORE EDWIN HUNTER III M.ED.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 7305 STONE CROSSING DR
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City | FREDERICKSBURG
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State | VA
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Zip | 22407-7360
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Country | US
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Telephone | 540-226-5294
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 LASKIN RD STE 102
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-5274
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Country | US
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Telephone | 757-689-7971
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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 | 0704015621
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License Number State | VA
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