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17 Crestview Dr Rustburg VA 24588-4033 | |
(434) 610-2215 | |
Not Available |
Full Name | |
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Speciality | Counselor - Professional |
Location | 17 Crestview Dr, Rustburg, Virginia |
Authorized Official Name and Position | Bryan John Prinzivalli (OWNER) |
Authorized Official Contact | 4346102215 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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17 Crestview Dr Rustburg VA 24588-4033 Ph: (434) 610-2215 | 17 Crestview Dr Rustburg VA 24588-4033 Ph: (434) 610-2215 |
NPI Number | 1932635075 |
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Provider Enumeration Date | 05/11/2017 |
Last Update Date | 05/11/2017 |
Identifier | Type | State | Issuer |
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1932635075 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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101YP2500X | Counselor - Professional | 0701005780 (Virginia) | Primary |