Provider Demographics
NPI:1285102954
Name:RUDISILL, TONI YVETTE (LPC)
Entity type:Individual
Prefix:MS
First Name:TONI
Middle Name:YVETTE
Last Name:RUDISILL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 BELVEDERE DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5413
Mailing Address - Country:US
Mailing Address - Phone:757-405-8665
Mailing Address - Fax:757-686-9797
Practice Address - Street 1:3210 CHURCHLAND BLVD STE 2
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5253
Practice Address - Country:US
Practice Address - Phone:757-966-2162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty