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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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