Provider Demographics
NPI:1790340156
Name:WYTHE COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:WYTHE COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:MINNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDAMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:276-613-4273
Mailing Address - Street 1:170 NOTTINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-1412
Mailing Address - Country:US
Mailing Address - Phone:276-613-4273
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-2302
Practice Address - Country:US
Practice Address - Phone:276-613-4273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)