| Mountain Laurel Group, Llc | |
|
102 N Main St Ste 300 Culpeper VA 22701-3053 | |
| (540) 829-1789 | |
| (540) 829-0117 |
| Full Name | Mountain Laurel Group, Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 102 N Main St Ste 300, Culpeper, Virginia |
| Authorized Official Name and Position | Bruce C. Wyman (CEO/ DIRECTOR) |
| Authorized Official Contact | 5408291789 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mountain Laurel Group, Llc 102 N Main St Ste 300 Culpeper VA 22701-3053 Ph: (540) 829-1789 | Mountain Laurel Group, Llc 102 N Main St Ste 300 Culpeper VA 22701-3053 Ph: (540) 829-1789 |
| NPI Number | 1548587405 |
|---|---|
| Provider Enumeration Date | 04/30/2010 |
| Last Update Date | 01/26/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548587405 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 0701003919 (Virginia) | Primary |
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