Provider Demographics
NPI:1720124902
Name:KOCH, SALLY SKEETERS (EDS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SALLY
Middle Name:SKEETERS
Last Name:KOCH
Suffix:
Gender:F
Credentials:EDS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 N AUGUSTA ST
Mailing Address - Street 2:PEOPLE PLACES, INC.
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3203
Mailing Address - Country:US
Mailing Address - Phone:540-885-8841
Mailing Address - Fax:540-886-6379
Practice Address - Street 1:1215 N AUGUSTA ST
Practice Address - Street 2:PEOPLE PLACES, INC.
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3203
Practice Address - Country:US
Practice Address - Phone:540-885-8841
Practice Address - Fax:540-886-6379
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001390101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor