Provider Demographics
NPI:1275706400
Name:WEST, DAN E JR (LPC)
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:E
Last Name:WEST
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 1:104A HOMESTEAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551
Mailing Address - Country:US
Mailing Address - Phone:434-660-2917
Mailing Address - Fax:
Practice Address - Street 1:104A HOMESTEAD DRIVE
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551
Practice Address - Country:US
Practice Address - Phone:434-660-2917
Practice Address - Fax:434-316-0026
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-09
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004035101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11831670OtherANTHEM