Healthcare Provider Details

I. General information

NPI: 1912592023
Provider Name (Legal Business Name): MOUNTAINSIDE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2021
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 VIRGINIA AVE
HARRISONBURG VA
22802-3921
US

IV. Provider business mailing address

2439 FAIRVIEW RD
MOUNT CRAWFORD VA
22841-2901
US

V. Phone/Fax

Practice location:
  • Phone: 540-742-7550
  • Fax: 855-429-4120
Mailing address:
  • Phone: 540-742-7550
  • Fax: 855-429-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY MCNEIL LOWN
Title or Position: OWNER/LEAD CLINICIAN
Credential: LPC
Phone: 540-742-7550