Provider Demographics
NPI:1295834943
Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS INC.
Entity Type:Organization
Organization Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-984-0023
Mailing Address - Street 1:911 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22902-5355
Mailing Address - Country:US
Mailing Address - Phone:434-984-0023
Mailing Address - Fax:434-984-4852
Practice Address - Street 1:911 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5355
Practice Address - Country:US
Practice Address - Phone:434-984-0023
Practice Address - Fax:434-984-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty