Provider Demographics
NPI:1780495473
Name:CHURCH, VIRGINIA IRENE (HIS)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:IRENE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:IRENE
Other - Last Name:HERINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-4250
Mailing Address - Country:US
Mailing Address - Phone:910-620-8191
Mailing Address - Fax:
Practice Address - Street 1:646 RIVER HWY
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9055
Practice Address - Country:US
Practice Address - Phone:704-360-6036
Practice Address - Fax:704-660-3172
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1699237700000X
NC1593237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist