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General NPI Number Information
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NPI Number | 1710878657
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Entity Type | Individual
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Provider Name | THERESA COUNCIL AU.D
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Gender | Female
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 430 MCLAWS CIR STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-5655
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Country | US
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Telephone | 757-229-4004
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 W CLAY ST APT 715B
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City | RICHMOND
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State | VA
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Zip | 23230-4666
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Country | US
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Telephone | 267-230-8678
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201002027
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License Number State | VA
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