Basic Information
Provider Information | |||||||||
NPI: | 1598763765 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MCNULTY | ||||||||
FirstName: | CHARLOTTE | ||||||||
MiddleName: | V | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
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: | 5404338277 | ||||||||
Practice Location | |||||||||
Address1: | 1241 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | HARRISONBURG | ||||||||
State: | VA | ||||||||
PostalCode: | 228024632 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5404341941 | ||||||||
FaxNumber: | 5404338277 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/12/2005 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 0701001120 | VA | X |   | Behavioral Health & Social Service Providers | Counselor |   | 101YM0800X | 0701001120 | VA | X |   | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 0701001120 | VA | X |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.