Provider Demographics
NPI:1093391757
Name:WEBB, MARY (LABA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 MIDLOTHIAN TPKE STE 100
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4700
Mailing Address - Country:US
Mailing Address - Phone:804-897-1753
Mailing Address - Fax:888-535-3417
Practice Address - Street 1:10800 MIDLOTHIAN TPKE STE 100
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-4700
Practice Address - Country:US
Practice Address - Phone:804-897-1753
Practice Address - Fax:888-535-3417
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0-20-11262103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst