Provider Demographics
NPI:1932635075
Name:BRYANJPRINZIVALLI
Entity Type:Organization
Organization Name:BRYANJPRINZIVALLI
Other - Org Name:VIP COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PRINZIVALLI
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, ACS
Authorized Official - Phone:434-610-2215
Mailing Address - Street 1:17 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RUSTBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24588-4033
Mailing Address - Country:US
Mailing Address - Phone:434-610-2215
Mailing Address - Fax:
Practice Address - Street 1:17 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RUSTBURG
Practice Address - State:VA
Practice Address - Zip Code:24588-4033
Practice Address - Country:US
Practice Address - Phone:434-610-2215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005780101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty