Healthcare Provider Details

I. General information

NPI: 1750954038
Provider Name (Legal Business Name): DOVE COUNSELING SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 07/23/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6558 MAIN ST MORGAN BLDG. STE 1
GLOUCESTER VA
23061-2306
US

IV. Provider business mailing address

PO BOX 549
GLOUCESTER VA
23061-0549
US

V. Phone/Fax

Practice location:
  • Phone: 804-699-3238
  • Fax: 804-699-3731
Mailing address:
  • Phone: 804-699-3238
  • Fax: 804-699-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ROBIN P FLETCHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 804-725-3337