| Lynessa Glass, Inc. | |
|
4356 Bonney Rd Building 1, Suite 101 Virginia Beach VA 23452-1200 | |
| (757) 717-0605 | |
| (757) 498-3311 |
| Full Name | Lynessa Glass, Inc. |
|---|---|
| Speciality | Counselor - Professional |
| Location | 4356 Bonney Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | Lynessa Glass (DIRECTOR) |
| Authorized Official Contact | 7577170605 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lynessa Glass, Inc. 4356 Bonney Rd Building 1, Suite 101 Virginia Beach VA 23452-1200 Ph: (757) 717-0605 | Lynessa Glass, Inc. 4356 Bonney Rd Building 1, Suite 101 Virginia Beach VA 23452-1200 Ph: (757) 717-0605 |
| NPI Number | 1366565954 |
|---|---|
| Provider Enumeration Date | 04/09/2007 |
| Last Update Date | 09/30/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366565954 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 0701002709 (Virginia) | Primary |
| 106H00000X | Marriage & Family Therapist | 0717000634 (Virginia) | Secondary |
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