MEDICARE: GROWING AWARENESS COUNSELING 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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1558039396	OTHER	VA	INDIVIDUAL LICENSE NUMBER

General Provider Information

NPI Number	:	1538926969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GROWING AWARENESS COUNSELING LLC

Provider Business Mailing Address
First Line	:	116 LANDMARK SQ
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23452-6872
Country	:	US
Telephone Number	:	757-288-9139
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 LANDMARK SQ STE 103
Second Line	:
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23452-6872
Country	:	US
Telephone Number	:	757-288-9139
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	CHARLYN LAGAYA TAYLOR-TOUPIN
Credential	:	LPC
Telephone Number	:	757-288-9139

Provider Enumeration Date	:	03/04/2024
Last Update Date	:	10/29/2024

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