Provider Demographics
NPI:1013984301
Name:WEAVER, JUDITH G (LPC)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:G
Last Name:WEAVER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 WHITE OAK CIR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8788
Mailing Address - Country:US
Mailing Address - Phone:540-433-1291
Mailing Address - Fax:540-743-3788
Practice Address - Street 1:320 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3630
Practice Address - Country:US
Practice Address - Phone:540-433-1291
Practice Address - Fax:540-743-3788
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-05
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005403561Medicaid
VA005403553Medicaid
VA541693876Medicare UPIN