Provider Demographics
NPI:1164628764
Name:WEAVER, DAVID JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:WEAVER
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 CAPE HENRY AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-2219
Mailing Address - Country:US
Mailing Address - Phone:757-282-6904
Mailing Address - Fax:757-282-6905
Practice Address - Street 1:3006 CAPE HENRY AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-2219
Practice Address - Country:US
Practice Address - Phone:757-282-6904
Practice Address - Fax:757-282-6905
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002757101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional