Organization
MOUNTAIN LAUREL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE CHARLES WYMAN EDM,NCC,LPC (CEO)
(540) 829-1789
Entity
Organization
Contact information
Practice address
102 N MAIN ST STE 300, CULPEPER, VA 22701-3053
(540) 829-1789
(540) 829-0117
Mailing address
102 N MAIN ST STE 300, CULPEPER, VA 22701-3053
(540) 829-1789
(540) 829-0117
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
993-14-001
VA
Other
Enumeration date
01/15/2009
Last updated
01/26/2012
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