1871963991 NPI number — VICK JOHNS COUNSELING & CONSULTING

Table of content: PATRICIA LOUISE POOLE PHARM.D. (NPI 1386665941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871963991 NPI number — VICK JOHNS COUNSELING & CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICK JOHNS COUNSELING & CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871963991
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16354 RUSTY RUDDER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22191-6357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-398-9381
Provider Business Mailing Address Fax Number:
703-680-0145

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16354 RUSTY RUDDER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22191-6357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-398-9381
Provider Business Practice Location Address Fax Number:
703-680-0145
Provider Enumeration Date:
10/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
VICKI
Authorized Official Middle Name:
YVETTE
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
703-398-9381

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  0904005349 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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