Provider Demographics
NPI:1205414927
Name:AUTRY, JOSEPH BENJAMIN (LPC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BENJAMIN
Last Name:AUTRY
Suffix:
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 1:492 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3408
Mailing Address - Country:US
Mailing Address - Phone:276-226-2828
Mailing Address - Fax:540-765-4118
Practice Address - Street 1:492 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3408
Practice Address - Country:US
Practice Address - Phone:276-226-2828
Practice Address - Fax:540-765-4118
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010290101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health