Provider Demographics
NPI:1629238852
Name:PICONE, THERESA ANN (LCMHC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:PICONE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MOOREFIELD PARK DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3683
Mailing Address - Country:US
Mailing Address - Phone:804-272-3917
Mailing Address - Fax:804-272-9798
Practice Address - Street 1:808 MOOREFIELD PARK DR
Practice Address - Street 2:SUITE 119
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-3683
Practice Address - Country:US
Practice Address - Phone:804-272-3917
Practice Address - Fax:804-272-9798
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068-0000461101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health