Provider Demographics
NPI:1043978448
Name:DUFFOUR, BETHANY GRACE (LPC)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:GRACE
Last Name:DUFFOUR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11357 NUCKOLS RD # 1339
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5504
Mailing Address - Country:US
Mailing Address - Phone:804-223-2150
Mailing Address - Fax:
Practice Address - Street 1:11357 NUCKOLS RD # 1339
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5504
Practice Address - Country:US
Practice Address - Phone:804-223-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010664101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health