Provider Demographics
NPI:1023443389
Name:COLBY, LARRY JOSEPH (LPC)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:JOSEPH
Last Name:COLBY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9618 LEAVELLS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4312
Mailing Address - Country:US
Mailing Address - Phone:703-419-0168
Mailing Address - Fax:
Practice Address - Street 1:10908 COURTHOUSE RD STE 102239
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2658
Practice Address - Country:US
Practice Address - Phone:804-573-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007075101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health