Healthcare Provider Details

I. General information

NPI: 1821785650
Provider Name (Legal Business Name): JC & ASHLEY COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/21/2023
Certification Date: 04/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E HICKS ST STE 200
LAWRENCEVILLE VA
23868-1830
US

IV. Provider business mailing address

102 E HICKS ST STE 200
LAWRENCEVILLE VA
23868-1830
US

V. Phone/Fax

Practice location:
  • Phone: 434-532-8214
  • Fax: 434-532-8215
Mailing address:
  • Phone: 434-532-8214
  • Fax: 434-532-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JESSICA ASHLEY
Title or Position: CEO
Credential:
Phone: 252-904-2808