Healthcare Provider Details

I. General information

NPI: 1750993887
Provider Name (Legal Business Name): LICENSED PROFESSIONAL COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 CROSSWAYS BLVD
CHESAPEAKE VA
23320-0205
US

IV. Provider business mailing address

1545 CROSSWAYS BLVD
CHESAPEAKE VA
23320-0205
US

V. Phone/Fax

Practice location:
  • Phone: 757-309-1405
  • Fax:
Mailing address:
  • Phone: 757-309-1405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KIM RICHARDSON
Title or Position: CREDENTIALING
Credential:
Phone: 757-907-2567