Healthcare Provider Details

I. General information

NPI: 1952880502
Provider Name (Legal Business Name): EXQUISITE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 CLAIBORNE SQ E STE 343
HAMPTON VA
23666-2071
US

IV. Provider business mailing address

9 CINDY CT
HAMPTON VA
23666-5632
US

V. Phone/Fax

Practice location:
  • Phone: 757-969-8584
  • Fax: 757-826-4681
Mailing address:
  • Phone: 757-969-8584
  • Fax: 757-826-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number130655
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DIANE L DAVIS
Title or Position: CEO/EXECUTIVE DIRECTOR
Credential: M.S., QMHP-A/C
Phone: 757-969-8584