Provider Demographics
NPI:1699479543
Name:KLABUNDE, MARY ELIZABETH (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:KLABUNDE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:KENT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MARY KLABUNDE, LPC
Mailing Address - Street 1:13835 HAPPY HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6610
Mailing Address - Country:US
Mailing Address - Phone:804-314-2330
Mailing Address - Fax:804-314-2330
Practice Address - Street 1:1525 HUGUENOT RD STE 100
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2438
Practice Address - Country:US
Practice Address - Phone:804-924-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional