Provider Demographics
NPI:1275520231
Name:FLETCHER, CONSTANCE N (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:N
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 MAIN ST STE 5
Mailing Address - Street 2:COUNSELING AND PSYCHOLOGICAL SERVICES, LLC
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1800
Mailing Address - Country:US
Mailing Address - Phone:434-792-2277
Mailing Address - Fax:434-792-2279
Practice Address - Street 1:108 HOLBROOK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1758
Practice Address - Country:US
Practice Address - Phone:434-791-2059
Practice Address - Fax:434-791-2835
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00753896Medicaid
VA680000124Medicare ID - Type Unspecified
VAR68326Medicare UPIN