Provider Demographics
NPI:1083778039
Name:PROFESSIONAL ALTERNATIVES, PLC
Entity Type:Organization
Organization Name:PROFESSIONAL ALTERNATIVES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:NOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-825-2788
Mailing Address - Street 1:219 E DAVIS ST
Mailing Address - Street 2:STE 310
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3001
Mailing Address - Country:US
Mailing Address - Phone:540-825-2788
Mailing Address - Fax:540-825-1244
Practice Address - Street 1:219 E DAVIS ST
Practice Address - Street 2:STE 310
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3001
Practice Address - Country:US
Practice Address - Phone:540-825-2788
Practice Address - Fax:540-825-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040013661041C0700X
VA09040011231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC04329Medicare PIN