Provider Demographics
NPI:1114122579
Name:BYRNE, PHYLLIS (LPC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:
Last Name:BYRNE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:VA
Mailing Address - Zip Code:22508-0261
Mailing Address - Country:US
Mailing Address - Phone:540-270-1357
Mailing Address - Fax:540-547-9432
Practice Address - Street 1:4448 GERMANNA HWY STE 7C
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:VA
Practice Address - Zip Code:22508-2012
Practice Address - Country:US
Practice Address - Phone:540-972-0504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional