Provider Demographics
NPI:1992032692
Name:SHENANDOAH VALLEY CENTER FOR INTEGRAL COUNSELING, LLC
Entity Type:Organization
Organization Name:SHENANDOAH VALLEY CENTER FOR INTEGRAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-248-1801
Mailing Address - Street 1:113 MILL PLACE PKWY
Mailing Address - Street 2:UNIT 101
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2662
Mailing Address - Country:US
Mailing Address - Phone:540-248-1801
Mailing Address - Fax:540-248-1802
Practice Address - Street 1:113 MILL PLACE PKWY
Practice Address - Street 2:UNIT 101
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2662
Practice Address - Country:US
Practice Address - Phone:540-248-1801
Practice Address - Fax:540-248-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty