Provider Demographics
NPI:1033831680
Name:ROSE, MICHAEL STEPHENS JR (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STEPHENS
Last Name:ROSE
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6184 JAMES D HAGOOD HWY
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24589-2681
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6184 JAMES D HAGOOD HWY
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:VA
Practice Address - Zip Code:24589-2681
Practice Address - Country:US
Practice Address - Phone:804-840-7499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty