Healthcare Provider Details

I. General information

NPI: 1750463618
Provider Name (Legal Business Name): ASSOCIATES IN COUNSELING AND FAMILY THERAPY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 W ELLERSLIE AVE
COLONIAL HEIGHTS VA
23834-1513
US

IV. Provider business mailing address

PO BOX 579
COLONIAL HEIGHTS VA
23834-0579
US

V. Phone/Fax

Practice location:
  • Phone: 804-520-1655
  • Fax:
Mailing address:
  • Phone: 804-520-1655
  • Fax: 804-520-8595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateVA

VIII. Authorized Official

Name: MISS JACKIE P POLLARD
Title or Position: DIRECTOR/ADMINISTRATOR
Credential: LPC, LMFT, MAC, NCC
Phone: 804-520-1655