=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669546875
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MENTAL HEALTH AMERICA OF CENTRAL VIRGINIA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2316 ATHERHOLT RD SUITE 206
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-316-9339
-----------------------------------------------------
Fax | 434-316-7025
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2316 ATHERHOLT RD SUITE 206
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501-2100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-316-9339
-----------------------------------------------------
Fax | 434-316-7025
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MS. NORMA S WHITE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 434-316-9339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 0701002466
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------