Provider Demographics
NPI:1619156734
Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC.
Entity Type:Organization
Organization Name:CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC.
Other - Org Name:LYNCHBURG LEAGUE OF THERAPISTS
Other - Org Type:Other Name
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-455-7990
Mailing Address - Street 1:523 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24504-2445
Mailing Address - Country:US
Mailing Address - Phone:434-455-7990
Mailing Address - Fax:434-455-0256
Practice Address - Street 1:523 CLAY ST
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24504-2445
Practice Address - Country:US
Practice Address - Phone:434-455-7990
Practice Address - Fax:434-455-0256
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLOTTESVILLE LEAGUE OF THERAPISTS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty