Provider Demographics
NPI:1649726522
Name:KONKEL, JOHN WILLIS (LPC)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WILLIS
Last Name:KONKEL
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 453
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0453
Mailing Address - Country:US
Mailing Address - Phone:757-442-3636
Mailing Address - Fax:757-442-2932
Practice Address - Street 1:10129 ROGERS DRIVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-442-3636
Practice Address - Fax:757-442-2932
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional