Basic Information
Provider Information
NPI: 1033530027
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NIPE
FirstName: GEORGE
MiddleName: MAYNARD
NamePrefix:  
NameSuffix: III
Credential: L.P.C.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1241 N MAIN ST
Address2:  
City: HARRISONBURG
State: VA
PostalCode: 228024632
CountryCode: US
TelephoneNumber: 5404341941
FaxNumber: 5404340132
Practice Location
Address1: 1241 N MAIN ST
Address2:  
City: HARRISONBURG
State: VA
PostalCode: 22802
CountryCode: US
TelephoneNumber: 5404341941
FaxNumber: 5404344378
Other Information
ProviderEnumerationDate: 12/18/2013
LastUpdateDate: 05/08/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/08/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X0701005647VAY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home