Provider Demographics
NPI:1093020489
Name:WILLIAMSBURG COUNSELING
Entity Type:Organization
Organization Name:WILLIAMSBURG COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVERICH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, MED, NCC
Authorized Official - Phone:757-903-2406
Mailing Address - Street 1:286 E QUEENS DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5042
Mailing Address - Country:US
Mailing Address - Phone:757-903-2406
Mailing Address - Fax:
Practice Address - Street 1:500 STRAWBERRY PLAINS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-3442
Practice Address - Country:US
Practice Address - Phone:757-903-2406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0717001251251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health