Provider Demographics
NPI:1528516549
Name:C'VILLE COUNSELING & OUTPATIENT THERAPY
Entity type:Organization
Organization Name:C'VILLE COUNSELING & OUTPATIENT THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:MANNERS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-870-7757
Mailing Address - Street 1:5 LONGWOOD PL
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-2850
Mailing Address - Country:US
Mailing Address - Phone:434-207-3615
Mailing Address - Fax:
Practice Address - Street 1:175 S PANTOPS DR
Practice Address - Street 2:ROOM 101
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8610
Practice Address - Country:US
Practice Address - Phone:276-870-7757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005612101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty