Provider Demographics
NPI:1689053894
Name:ROSS, VIRGINIA (MS, NCC, LMHC,LCPC)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:MS, NCC, LMHC,LCPC
Other - Prefix:
Other - First Name:JANA
Other - Middle Name:
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:27442 S. LACON LANE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:ID
Mailing Address - Zip Code:83833
Mailing Address - Country:US
Mailing Address - Phone:509-999-7086
Mailing Address - Fax:
Practice Address - Street 1:27442 S. LACON LANE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:ID
Practice Address - Zip Code:83833
Practice Address - Country:US
Practice Address - Phone:509-999-7086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6102101YM0800X
IDLCPC-7897101YM0800X
WALH60549703101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health