Provider Demographics
NPI:1003439043
Name:FRANCIS, MARY (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:FRANCIS
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 1:175 SUMMIT WAY SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5156
Mailing Address - Country:US
Mailing Address - Phone:804-370-0058
Mailing Address - Fax:
Practice Address - Street 1:175 SUMMIT WAY SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5156
Practice Address - Country:US
Practice Address - Phone:804-370-0058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-26
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701009072101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional