Healthcare Provider Details

I. General information

NPI: 1740879683
Provider Name (Legal Business Name): GREAT BLUE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 02/03/2025
Certification Date: 02/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2723 W GRACE ST
RICHMOND VA
23220-1912
US

IV. Provider business mailing address

2723 W GRACE ST
RICHMOND VA
23220-1912
US

V. Phone/Fax

Practice location:
  • Phone: 804-401-6947
  • Fax:
Mailing address:
  • Phone: 804-401-6947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TONYA LEA BEERS-WARMAN
Title or Position: THERAPIST
Credential: LPC
Phone: 804-401-6947