Provider Demographics
NPI:1346786852
Name:CENTRAL VIRGINIA COUNSELING PLLC
Entity type:Organization
Organization Name:CENTRAL VIRGINIA COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PETTY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:434-473-2291
Mailing Address - Street 1:808 WIGGINGTON RD STE D
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5155
Mailing Address - Country:US
Mailing Address - Phone:434-473-2291
Mailing Address - Fax:
Practice Address - Street 1:808 WIGGINGTON RD STE D
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5155
Practice Address - Country:US
Practice Address - Phone:434-473-2291
Practice Address - Fax:540-765-3369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005872251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health