Provider Demographics
NPI:1457495384
Name:PERRY, MARK WILLIAMS (LPC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAMS
Last Name:PERRY
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 1:3149 RIDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7207
Mailing Address - Country:US
Mailing Address - Phone:434-974-1564
Mailing Address - Fax:
Practice Address - Street 1:800 PRESTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4420
Practice Address - Country:US
Practice Address - Phone:434-972-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002080101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional