Healthcare Provider Details

I. General information

NPI: 1417578469
Provider Name (Legal Business Name): INNOVATIVE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11815 FOUNTAIN WAY STE 300
NEWPORT NEWS VA
23606-4448
US

IV. Provider business mailing address

11815 FOUNTAIN WAY STE 300
NEWPORT NEWS VA
23606-4448
US

V. Phone/Fax

Practice location:
  • Phone: 757-606-9388
  • Fax:
Mailing address:
  • Phone: 757-606-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ALAFEYA BAILEY
Title or Position: CLINICIAN
Credential: LCSW
Phone: 757-606-9388