MEDICARE: PROMINENT COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093282790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROMINENT COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	8014 MIDLOTHIAN TPKE STE 315
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5291
Country	:	US
Telephone Number	:	804-716-8908
Fax Number	:	866-216-5506

Provider Business Practice Location Address
First Line	:	8014 MIDLOTHIAN TPKE STE 315
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23235-5291
Country	:	US
Telephone Number	:	804-716-8908
Fax Number	:	866-216-5506

Authorized Official
Title or Position	:	CEO/QMHP
Name	:	MS. ANGELA D CRAIGHEAD
Credential	:
Telephone Number	:	804-716-8908

Provider Enumeration Date	:	10/31/2018
Last Update Date	:	10/31/2018

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