Provider Demographics
NPI:1508072554
Name:PERRY, VIRGINIA D (LMFT, LPC)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:D
Last Name:PERRY
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026 REYNOLDA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5113
Mailing Address - Country:US
Mailing Address - Phone:336-722-6310
Mailing Address - Fax:
Practice Address - Street 1:2100 REYNOLDA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5115
Practice Address - Country:US
Practice Address - Phone:336-721-0540
Practice Address - Fax:336-724-0099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist