=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639755689
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HOPE ANITA AYERS-GRAY LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2021
-----------------------------------------------------
Last Update Date | 03/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1510 WILLOW LAWN DR
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23230-3429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-404-5499
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6212 RIDDLE CT
-----------------------------------------------------
City | CHESTERFIELD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23832-6811
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-303-9910
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701008374
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------