Provider Demographics
NPI:1881897551
Name:BOOHER, VIRGINIA BROOKE (MA)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:BROOKE
Last Name:BOOHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 WHIRLAWAY CT
Mailing Address - Street 2:UNIT D
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7742
Mailing Address - Country:US
Mailing Address - Phone:336-918-8983
Mailing Address - Fax:
Practice Address - Street 1:220 E 1ST AVE
Practice Address - Street 2:SUITE 10
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-3317
Practice Address - Country:US
Practice Address - Phone:336-242-2450
Practice Address - Fax:336-249-9920
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health