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General NPI Number Information
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NPI Number | 1609334275
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Entity Type | Individual
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Provider Name | LAURA BETH OLLIFF MAPC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2019
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Last Update Date | 03/03/2019
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Provider Practice Location Address
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Address Line | 12000 WYNDHAM LAKE DR STE B
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City | GLEN ALLEN
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State | VA
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Zip | 23059-7072
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Country | US
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Telephone | 804-592-2793
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Fax | 804-592-2794
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Provider Business Mailing Address
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Address Line | 12930 CRESCENT GRN APT 305
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-5573
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Country | US
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Telephone | 912-856-6964
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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 | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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