MEDICARE: TEAM COUNSELING AND PSYCHOLOGICAL SERVICES, INCORPORATED

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	0810004046	VA

General Provider Information

NPI Number	:	1801100862
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEAM COUNSELING AND PSYCHOLOGICAL SERVICES, INCORPORATED

Provider Business Mailing Address
First Line	:	10712 TOSTON LN
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6496
Country	:	US
Telephone Number	:	804-967-0936
Fax Number	:	804-967-2151

Provider Business Practice Location Address
First Line	:	10712 TOSTON LN
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-6496
Country	:	US
Telephone Number	:	804-967-0936
Fax Number	:	804-967-2151

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	DR. CHARLYNN PHILLIS SMALL
Credential	:	PHD
Telephone Number	:	804-967-0936

Provider Enumeration Date	:	08/02/2010
Last Update Date	:	08/02/2010

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