Individual
MARY KAY ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
600 LEE HWY, VERONA, VA 24482-2501
(540) 290-3144
Mailing address
3895 SHUTTERLEE MILL RD, STAUNTON, VA 24401-6312
(540) 290-3144
(408) 886-0138
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
0701003775
VA
101YP2500X
Professional Counselor
PRC2000002
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010135222
—
VA
01
—
082521M
OPTIMA BEHAVIORAL
VA
01
—
175935
ANTHEM
VA
01
—
5592438
FIRST HEALTH
VA
Enumeration date
02/15/2006
Last updated
10/13/2023
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