Organization
MOUNTAIN LAUREL GROUP, LLC
Active
Organization
MOUNTAIN LAUREL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE WYMAN LPC, EDM (CEO-DIRECTOR OF PROGRAMS- OWNER)
(540) 937-2334
Entity
Organization
Contact information
Practice address
14274 EGGBORNSVILLE RD, CULPEPER, VA 22701-4844
(540) 829-1789
(540) 829-0117
Mailing address
10391 GREYSON LN, RIXEYVILLE, VA 22737-1730
(540) 937-2334
(540) 937-7680
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
993-01019
VA
Other
Enumeration date
04/06/2010
Last updated
04/06/2010
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