Provider Demographics
NPI:1336928506
Name:SEGOVIA CHAVEZ, LARY CAROLINA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:LARY
Middle Name:CAROLINA
Last Name:SEGOVIA CHAVEZ
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 1:3 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2800
Mailing Address - Country:US
Mailing Address - Phone:619-602-5252
Mailing Address - Fax:
Practice Address - Street 1:700 TECH CENTER PKWY STE 200-43
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3075
Practice Address - Country:US
Practice Address - Phone:619-602-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010093101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional