Healthcare Provider Details

I. General information

NPI: 1396233730
Provider Name (Legal Business Name): CPJ COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2832 COPPERSMITH PLACE
BRYANS ROAD MD
20616
US

IV. Provider business mailing address

3402 DELAWARE AVE
RICHMOND VA
23222-2913
US

V. Phone/Fax

Practice location:
  • Phone: 804-322-7185
  • Fax: 804-884-3855
Mailing address:
  • Phone: 202-230-4554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701006947
License Number StateVA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JETTIE NORFLEET
Title or Position: OWNER/ CLINICIAN
Credential: LPC
Phone: 202-230-4554