Basic Information
| Provider Information | |||||||||
| NPI: | 1881897551 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOOHER | ||||||||
| FirstName: | VIRGINIA | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4011 WHIRLAWAY CT | ||||||||
| Address2: | UNIT D | ||||||||
| City: | CLEMMONS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270127742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3369188983 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 220 E 1ST AVE | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 272923317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3362422450 | ||||||||
| FaxNumber: | 3362499920 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2007 | ||||||||
| LastUpdateDate: | 06/10/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.