Healthcare Provider Details

I. General information

NPI: 1952999377
Provider Name (Legal Business Name): HALFWILD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2021
Last Update Date: 01/03/2021
Certification Date: 01/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 S RAILROAD AVE STE G
ASHLAND VA
23005-2090
US

IV. Provider business mailing address

13364 VERDON RD
RUTHER GLEN VA
22546-2248
US

V. Phone/Fax

Practice location:
  • Phone: 804-994-1897
  • Fax:
Mailing address:
  • Phone: 804-994-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY MARGARET SIGNORELLI
Title or Position: COUNSELOR
Credential: LPC
Phone: 804-994-1897