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Individual

MATTHEW VERNON BUKOWSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
1001 E MARKET ST, CHARLOTTESVILLE, VA 22902-5381
(434) 270-0571
(240) 595-6198
Mailing address
134 LEAKE LN, CHARLOTTESVILLE, VA 22902-5476
(434) 270-0571
(240) 595-6198

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
0701007508
VA
101YM0800X
Mental Health Counselor
0701007508
VA
101YP2500X
Professional Counselor
Primary
0701007508
VA

Other

Enumeration date
05/05/2019
Last updated
03/03/2021
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