Healthcare Provider Details

I. General information

NPI: 1710704465
Provider Name (Legal Business Name): THE COUNSELING CORNER OF VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4108 E PARHAM RD STE 100
RICHMOND VA
23228-2754
US

IV. Provider business mailing address

4108 E PARHAM RD STE 100
RICHMOND VA
23228-2754
US

V. Phone/Fax

Practice location:
  • Phone: 434-414-8353
  • Fax:
Mailing address:
  • Phone: 434-414-8353
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CHRIS FREEMAN
Title or Position: CEO
Credential:
Phone: 434-414-8353