Provider Demographics
NPI:1093004871
Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC
Entity Type:Organization
Organization Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC
Other - Org Name:SOUTH CENTRAL LEAGUE OF THERAPISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:REGIONAL HR ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-984-0023
Mailing Address - Street 1:911 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5355
Mailing Address - Country:US
Mailing Address - Phone:434-984-0023
Mailing Address - Fax:434-984-4852
Practice Address - Street 1:1046 MAIN STREET
Practice Address - Street 2:
Practice Address - City:DILLWYN
Practice Address - State:VA
Practice Address - Zip Code:23936
Practice Address - Country:US
Practice Address - Phone:434-984-0023
Practice Address - Fax:434-984-4852
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA411101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty