Provider Demographics
NPI:1548858921
Name:HURTA, PENNIE JO (LPC)
Entity type:Individual
Prefix:MISS
First Name:PENNIE
Middle Name:JO
Last Name:HURTA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:739 THIMBLE SHOALS BLVD STE 706
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-3585
Mailing Address - Country:US
Mailing Address - Phone:757-838-8520
Mailing Address - Fax:757-595-0157
Practice Address - Street 1:739 THIMBLE SHOALS BLVD STE 706
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3585
Practice Address - Country:US
Practice Address - Phone:757-838-8520
Practice Address - Fax:757-595-0157
Is Sole Proprietor?:No
Enumeration Date:2021-01-01
Last Update Date:2021-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010187101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional