Healthcare Provider Details

I. General information

NPI: 1770013575
Provider Name (Legal Business Name): COURAGE HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2017
Last Update Date: 06/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 N WASHINGTON HWY STE F
ASHLAND VA
23005-1326
US

IV. Provider business mailing address

11090 HEMLOCK LN
DOSWELL VA
23047-2233
US

V. Phone/Fax

Practice location:
  • Phone: 803-210-5677
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0904009466
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0904009466
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number0904009466
License Number StateVA

VIII. Authorized Official

Name: MARGARET MCSHERRY
Title or Position: OWNER
Credential: LCSW
Phone: 803-210-5677