Provider Demographics
NPI:1508405283
Name:WEAVER, JOHNATHAN HAYES (LPC)
Entity Type:Individual
Prefix:
First Name:JOHNATHAN
Middle Name:HAYES
Last Name:WEAVER
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:PO BOX 38031
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-0831
Mailing Address - Country:US
Mailing Address - Phone:804-252-3958
Mailing Address - Fax:
Practice Address - Street 1:2530 PROFESSIONAL RD STE 201
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3217
Practice Address - Country:US
Practice Address - Phone:804-658-6760
Practice Address - Fax:804-658-7195
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional