Organization
MOUNTAIN LAUREL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE CHARLES WYMAN LPC (CEO)
(540) 829-1789
Entity
Organization
Contact information
Practice address
16126 BRANDY RD, CULPEPER, VA 22701-4622
(540) 829-1789
(540) 825-4617
Mailing address
PO BOX 507, CULPEPER, VA 22701-0507
(540) 829-1789
(540) 825-4617
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
05/14/2007
Last updated
11/20/2007
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