Healthcare Provider Details

I. General information

NPI: 1114607017
Provider Name (Legal Business Name): HEAL CENTER FOR COUNSELING AND COMPLEMENTARY HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23301 CEDAR MOUNTAIN DR
RAPIDAN VA
22733-1845
US

IV. Provider business mailing address

PO BOX 123
MITCHELLS VA
22729-0123
US

V. Phone/Fax

Practice location:
  • Phone: 540-717-4212
  • Fax:
Mailing address:
  • Phone: 540-717-4212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARMINDA BERNICE PERCH
Title or Position: FOUNDER
Credential: LCSW
Phone: 912-574-8702