MEDICARE: AVAIL OUTPATIENT 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	1041C0700X	Clinical Social Worker	0904008953	VA

General Provider Information

NPI Number	:	1881147627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVAIL OUTPATIENT COUNSELING LLC

Provider Business Mailing Address
First Line	:	901 LIVERPOOL CIR
Second Line	:	APT 202
City	:	CHESTER
State	:	VA
Zip	:	23836-2729
Country	:	US
Telephone Number	:	804-586-5679
Fax Number	:

Provider Business Practice Location Address
First Line	:	6523 CENTRALIA RD
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-6587
Country	:	US
Telephone Number	:	804-214-2260
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAWNRELL DENISE BLACKWELL
Credential	:
Telephone Number	:	804-214-2260

Provider Enumeration Date	:	07/28/2016
Last Update Date	:	07/28/2016

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