Provider Demographics
NPI:1154067163
Name:MIRPURI, MARTINE OLIVIA (LPC-E)
Entity Type:Individual
Prefix:
First Name:MARTINE
Middle Name:OLIVIA
Last Name:MIRPURI
Suffix:
Gender:F
Credentials:LPC-E
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5267 GREENWICH RD STE 101E
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6028
Mailing Address - Country:US
Mailing Address - Phone:757-779-4383
Mailing Address - Fax:
Practice Address - Street 1:5267 GREENWICH RD STE 101E
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6028
Practice Address - Country:US
Practice Address - Phone:757-779-4383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704011945101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health