# MOUNTAIN LAUREL GROUP, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1750596441
- **Authorized official:** MR. BRUCE CHARLES WYMAN LPC (CEO)
- **Authorized official phone:** (540) 829-1789

## Contact information

- **Practice address:** 16126 BRANDY RD, CULPEPER, VA 22701-4622
- **Practice address phone:** (540) 829-1789
- **Practice address fax:** (540) 825-4617
- **Mailing address:** PO BOX 507, CULPEPER, VA 22701-0507
- **Mailing address phone:** (540) 829-1789
- **Mailing address fax:** (540) 825-4617

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/14/2007
- **Last updated:** 11/20/2007