Provider Demographics
NPI:1093960809
Name:MICHAEL, VIRGINIA T (MED, LPC)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:T
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 OLD TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-6523
Mailing Address - Country:US
Mailing Address - Phone:570-524-9099
Mailing Address - Fax:570-524-9099
Practice Address - Street 1:2409 OLD TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-6523
Practice Address - Country:US
Practice Address - Phone:570-524-9099
Practice Address - Fax:570-524-9099
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002511101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional