# MOUNTAIN LAUREL GROUP LLC

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

## Provider details

- **NPI number:** 1992853436
- **Authorized official:** MR. BRUCE C WYMAN LPC,NCC,EDM (DIRECTOR/CEO)
- **Authorized official phone:** (540) 829-1789

## Contact information

- **Practice address:** 102 N MAIN ST STE 300, CULPEPER, VA 22701-3053
- **Practice address phone:** (540) 829-1789
- **Practice address fax:** (540) 829-0117
- **Mailing address:** 102 N MAIN ST STE 300, CULPEPER, VA 22701-3053
- **Mailing address phone:** (540) 829-1789
- **Mailing address fax:** (540) 829-0117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 322D00000X | Emotionally Disturbed Childrens' Residential Treatment Facility | 993-14-001 | VA | Yes |

## Other

- **Enumeration date:** 01/08/2007
- **Last updated:** 01/26/2012