Doctor Name: | LISA PUGH |
NPI Number: | 1689076150 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 0701005031 |
Business Practice Address: | 267 Allegany Spring Road # 10 B Shawsville, VA - 24162 |
Business Phone Number: | 5402681069 |
Business Fax Number: | 5402681045 |
Mailing Address: | Po Box 63, SHAWSVILLE |
State: | VA |
Postal Code: | 24162 |
Phone Number: | 5402681069 |
Fax Number: | 5402681045 |
NPI Enumeration Date: | 09/16/2014 |
NPI Last Update Date: | 09/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 0701005031 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |