Provider Demographics
NPI:1588724850
Name:COUNSELING ASSOCIATES OF WYTHEVILLE, LLC
Entity type:Organization
Organization Name:COUNSELING ASSOCIATES OF WYTHEVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:NCC, LMFT, LPC
Authorized Official - Phone:276-223-4443
Mailing Address - Street 1:420 E MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-2328
Mailing Address - Country:US
Mailing Address - Phone:276-223-4443
Mailing Address - Fax:276-223-0133
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2328
Practice Address - Country:US
Practice Address - Phone:276-223-4443
Practice Address - Fax:276-223-0133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001401101YP2500X
VA0717000805106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA039925OtherVALUE OPTIONS
VA2237697OtherCIGNA
VA423453OtherMAMSI
VAO-86315OtherSENTARA
VAVA0101OtherUBH, JOHN DEERE
VA023882OtherVMC BEHAVIORAL SERVICES
VA222129OtherPHCS
VA343697OtherMHN
VA423453OtherALLIANCE
VAO-86315OtherSOUTHERN HEALTH
VAO-86315OtherQUALCHOICE
VA32272OtherMHN
VA7805017OtherAETNA USHEALTHCARE