Active NPI
Mary Jo Betyak-Eisler
- Professional Counselor
- Stafford, VA
National Provider Identifier
1710741426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 0701005517
- Practice address
- 77 Wagoneers LN
Stafford, VA 22554-8521 - Phone
- (619) 507-7254
- NPI assigned
- Feb 13, 2024
- Last updated
- Aug 19, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0710102795 | VA | |
| Mental Health Counselor | 101YM0800X | 004087-01 | NY | |
| Professional Counselor | 101YP2500X | 0701005517 | VA | Primary |
Addresses
Primary practice location
77 Wagoneers LN
Stafford, VA 22554-8521
Mailing address
2027 Comradery Way
Murrells Inlet, SC 29576
Phone (619) 507-7254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0710102795 | VA | MD | Addiction (Substance Use Disorder) Counselor |
| 004087-01 | NY | MD | Mental Health Counselor |
| 0701005517 | VA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787097600000",
"number": "1710741426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2027 COMRADERY WAY",
"city": "MURRELLS INLET",
"state": "SC",
"postal_code": "29576",
"telephone_number": "619-507-7254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "77 WAGONEERS LN",
"city": "STAFFORD",
"state": "VA",
"postal_code": "225548521",
"telephone_number": "619-507-7254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BETYAK-EISLER",
"first_name": "MARY JO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-02-13",
"last_updated": "2026-08-19",
"certification_date": "2026-08-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "VA",
"license": "0710102795",
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NY",
"license": "004087-01",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "VA",
"license": "0701005517",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stafford, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.