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General NPI Number Information
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NPI Number | 1992287833
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Entity Type | Individual
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Provider Name | KATHRYN GOSS ATANASOV PHD, LPC, NCC, CSAC
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Gender | Female
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Dates
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Enumeration Date | 09/06/2018
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Last Update Date | 05/28/2020
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Provider Practice Location Address
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Address Line | FARLEY IOP WILLIAMSBURG PLACE 5477 MOORETOWN ROAD
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City | WILLIAMSBURG
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State | VA
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Zip | 23188
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Country | US
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Telephone | 757-280-1194
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Fax |
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Provider Business Mailing Address
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Address Line | 3493 FRANCES BERKELEY
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City | WILLIAMSBURG
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State | VA
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Zip | 23188-1334
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Country | US
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Telephone | 757-232-7108
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0710103039
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701007579
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License Number State | VA
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