Healthcare Provider Details

I. General information

NPI: 1902720105
Provider Name (Legal Business Name): SHIVA COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14880 FOREST RD
FOREST VA
24551-5008
US

IV. Provider business mailing address

14880 FOREST RD
FOREST VA
24551-5008
US

V. Phone/Fax

Practice location:
  • Phone: 434-505-8426
  • Fax: 434-302-9701
Mailing address:
  • Phone: 434-505-8426
  • Fax: 434-302-9701

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: BENJAMIN COOK
Title or Position: CEO, THERAPIST
Credential: LPC
Phone: 434-505-8426