MEDICARE: COUNSELING CONNECT, PLLC

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

General Provider Information

NPI Number	:	1750094371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COUNSELING CONNECT, PLLC

Provider Business Mailing Address
First Line	:	10 HICKOK ST STE 201
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-3569
Country	:	US
Telephone Number	:	540-315-1445
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 HICKOK ST STE 201
Second Line	:
City	:	CHRISTIANSBURG
State	:	VA
Zip	:	24073-3569
Country	:	US
Telephone Number	:	540-315-1445
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SUPERVISOR
Name	:	RACHEL BURGESS
Credential	:	LPC
Telephone Number	:	540-315-1445

Provider Enumeration Date	:	12/28/2022
Last Update Date	:	01/05/2023

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