Provider Demographics
NPI:1932246618
Name:LOOMAN, MARY D (PHD, LPC, CCFC)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:D
Last Name:LOOMAN
Suffix:
Gender:F
Credentials:PHD, LPC, CCFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8425 KLAREY CT
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-1873
Mailing Address - Country:US
Mailing Address - Phone:405-326-2256
Mailing Address - Fax:
Practice Address - Street 1:8425 KLAREY CT
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-1873
Practice Address - Country:US
Practice Address - Phone:405-326-2256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200230490AMedicaid