MEDICARE: TAILORED HOLISTIC COUNSELING LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency
3	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1942033444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAILORED HOLISTIC COUNSELING LLC

Provider Business Mailing Address
First Line	:	9221 FOREST HILL AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-6876
Country	:	US
Telephone Number	:	703-399-2197
Fax Number	:	703-544-4690

Provider Business Practice Location Address
First Line	:	6601 IRONGATE SQ STE C
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-6077
Country	:	US
Telephone Number	:	703-399-2197
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	DANIELLE THOMPSON
Credential	:	LPC
Telephone Number	:	703-399-2197

Provider Enumeration Date	:	08/21/2024
Last Update Date	:	12/01/2025

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