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General NPI Number Information
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NPI Number | 1811435142
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Entity Type | Individual
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Provider Name | AVRIAL T MENDOZA LPC
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Gender | Female
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 606 RIPPLEMEAD RD
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City | RIPPLEMEAD
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State | VA
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Zip | 24150-3106
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Country | US
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Telephone | 540-227-0005
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Fax | 877-384-3084
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Provider Business Mailing Address
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Address Line | PO BOX 32
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City | RIPPLEMEAD
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State | VA
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Zip | 24150-0032
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Country | US
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Telephone | 540-227-0005
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Fax | 877-384-3084
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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 | 0701005012
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License Number State | VA
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