Healthcare Provider Details

I. General information

NPI: 1801395942
Provider Name (Legal Business Name): CAPITAL COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12530 IRON BRIDGE RD STE K
CHESTER VA
23831-1599
US

IV. Provider business mailing address

2003 DINWIDDIE AVE
RICHMOND VA
23224-5221
US

V. Phone/Fax

Practice location:
  • Phone: 804-334-1865
  • Fax:
Mailing address:
  • Phone: 804-647-5321
  • Fax: 804-454-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number2747-03-001
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE ELIZABETH JORDAN
Title or Position: CEO
Credential: MS
Phone: 804-647-5321