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General NPI Number Information
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NPI Number | 1669197216
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Entity Type | Individual
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Provider Name | PATRICK KNICELY
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Gender | Male
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Dates
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Enumeration Date | 10/06/2022
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 901 N GLEBE RD
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City | ARLINGTON
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State | VA
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Zip | 22203-1853
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Country | US
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Telephone | 323-205-7088
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Fax |
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Provider Business Mailing Address
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Address Line | 2343 STALLION CIR
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City | ROANOKE
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State | VA
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Zip | 24018-6119
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Country | US
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Telephone | 540-315-2111
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701014036
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License Number State | VA
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