Provider Demographics
NPI:1083170286
Name:WITHERSPOON, MARSHA LYNETTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:LYNETTE
Last Name:WITHERSPOON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:MARSHA
Other - Middle Name:LYNETTE
Other - Last Name:WITHERSPOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4501 MCGILL ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-1929
Mailing Address - Country:US
Mailing Address - Phone:804-615-2306
Mailing Address - Fax:
Practice Address - Street 1:1510 WILLOW LAWN DR STE 100
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3429
Practice Address - Country:US
Practice Address - Phone:804-214-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA071007935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty