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General NPI Number Information
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NPI Number | 1528516549
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Entity Type | Organization
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Legal Business Name | C'VILLE COUNSELING & OUTPATIENT THERAPY
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/27/2016
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Provider Practice Location Address
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Address Line | 175 S PANTOPS DR ROOM 101
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22911-8610
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Country | US
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Telephone | 276-870-7757
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Fax |
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Provider Business Mailing Address
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Address Line | 5 LONGWOOD PL
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City | PALMYRA
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State | VA
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Zip | 22963-2850
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Country | US
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Telephone | 434-207-3615
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. LISA RENE MANNERS
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Credential | LPC
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Telephone | 276-870-7757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701005612
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License Number State | VA
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