Evangeline Hope Fennewald, LPC
Individual provider Active NPI Professional Counselor · Cedar Bluff, VA
NPI 1174883458 · NPPES record last updated May 21, 2012
Key facts
- NPI
- 1174883458
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- 0701005250 (VA)
- Practice address
- 113 Cumberland Road
Cedar Bluff, VA 24609-0810 - Phone
- (276) 964-6702
- Fax
- (276) 964-0292
- NPI assigned
- May 21, 2012
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701005250 | VA | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Highpower, PC | Current | Accepting new patients | |
| Cumberland Mountain Community Services | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 0701005250 | VA | Yes |
Addresses
Primary practice location
113 Cumberland Road
Cedar Bluff, VA 24609-0810
Mailing address
113 Cumberland Road
Cedar Bluff, VA 24609-0810
Phone (276) 964-6702
Other providers in Cedar Bluff, VA
- Connie Elkins
- Sara J Ellis
- Embrace, Behavioral Consulting
- Heather Elizabeth Evans
- Family Preservation Services, Inc
- Sarah Marie Fields
- Sheena Flanner
- Ashleigh Frazier
- Ashley Elaine Fuller
- Brittany Nicole Fuller
All providers in Cedar Bluff, VA · Professional Counselor in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 21, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.