Healthcare Provider Details

I. General information

NPI: 1922607977
Provider Name (Legal Business Name): RIVERS OF HOPE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 LAFAYETTE CENTER DR STE 1675
CHANTILLY VA
20151-1270
US

IV. Provider business mailing address

906 NE 13TH PL
CAPE CORAL FL
33909-1510
US

V. Phone/Fax

Practice location:
  • Phone: 855-326-4673
  • Fax:
Mailing address:
  • Phone: 855-326-4673
  • Fax: 703-842-8130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHARMAINE RENEE DOCKETT
Title or Position: THERAPIST/OWNER
Credential: LPC
Phone: 202-330-6034