Provider Demographics
NPI:1265727788
Name:CONGER, VIRGINIA L (MA, MFT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:L
Last Name:CONGER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:L
Other - Last Name:CONGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:2571 CALIFORNIA PARK DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-4042
Mailing Address - Country:US
Mailing Address - Phone:530-899-1005
Mailing Address - Fax:530-899-1005
Practice Address - Street 1:2571 CALIFORNIA PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4042
Practice Address - Country:US
Practice Address - Phone:530-899-1005
Practice Address - Fax:530-899-1005
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC12546101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health