Healthcare Provider Details

I. General information

NPI: 1245072503
Provider Name (Legal Business Name): 180 COUNSELING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2024
Last Update Date: 06/08/2024
Certification Date: 06/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 WATERSIDE DR
NORFOLK VA
23510-3300
US

IV. Provider business mailing address

2921 REPLICA LN
PORTSMOUTH VA
23703-5218
US

V. Phone/Fax

Practice location:
  • Phone: 757-977-8455
  • Fax: 757-765-6450
Mailing address:
  • Phone: 757-553-2352
  • Fax: 757-765-6450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGEL MARIE BUNTON
Title or Position: OWNER/PRESIDENT
Credential: LCSW
Phone: 757-553-2352