MEDICARE: MS. ROCHELLE M. NIGHTENGALE MS, LPC, C.R.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701004858	VA
2	101YM0800X	Mental Health Counselor	00051953	VA

General Provider Information

NPI Number	:	1386953164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROCHELLE M. NIGHTENGALE MS, LPC, C.R.C.

Provider Business Mailing Address
First Line	:	PO BOX 27872
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23261-7872
Country	:	US
Telephone Number	:	804-337-3277
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 W MARSHALL ST STE 215
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-4734
Country	:	US
Telephone Number	:	804-337-3277
Fax Number	:	804-249-4127

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2010
Last Update Date	:	10/29/2014

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