Healthcare Provider Details

I. General information

NPI: 1336917525
Provider Name (Legal Business Name): CONCRETE ROSES COUNSELING AND CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2023
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11237 MAGILL TERRACE DR
CHESTER VA
23831-6150
US

IV. Provider business mailing address

11237 MAGILL TERRACE DR
CHESTER VA
23831-6150
US

V. Phone/Fax

Practice location:
  • Phone: 540-827-9071
  • Fax:
Mailing address:
  • Phone: 540-827-9071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA NICOLE WHITLOW
Title or Position: CEO
Credential: LCSW
Phone: 540-827-9071