Provider Demographics
NPI:1942678123
Name:LIVERMAN, RICHARD WAYLON (LPC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:WAYLON
Last Name:LIVERMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 NARBONNE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4831
Mailing Address - Country:US
Mailing Address - Phone:757-467-1377
Mailing Address - Fax:
Practice Address - Street 1:1520 NARBONNE CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4831
Practice Address - Country:US
Practice Address - Phone:757-467-1377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional