Provider Demographics
NPI:1508537580
Name:HERRELL, KAREN ELIZABETH
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:HERRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:VA
Mailing Address - Zip Code:22812-1036
Mailing Address - Country:US
Mailing Address - Phone:540-246-4301
Mailing Address - Fax:
Practice Address - Street 1:1215 N AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3203
Practice Address - Country:US
Practice Address - Phone:540-885-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health