Healthcare Provider Details

I. General information

NPI: 1629804315
Provider Name (Legal Business Name): MENTAL HEALTH ADVOCATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SANTA ROSA RD RM 115
HENRICO VA
23229-5008
US

IV. Provider business mailing address

10712 PROVIDENCE PARK DR
ASHLAND VA
23005-7488
US

V. Phone/Fax

Practice location:
  • Phone: 804-690-2537
  • Fax:
Mailing address:
  • Phone: 804-690-2537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER ERICKSON
Title or Position: DIRECTOR
Credential: LPC
Phone: 804-690-2537