Healthcare Provider Details

I. General information

NPI: 1689736191
Provider Name (Legal Business Name): MEDICAL & COUNSELING ASSOC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 SANTA ROSA RD STE 211
RICHMOND VA
23229
US

IV. Provider business mailing address

1503 SANTA ROSA RD STE 211
RICHMOND VA
23229
US

V. Phone/Fax

Practice location:
  • Phone: 804-282-9100
  • Fax: 804-282-3266
Mailing address:
  • Phone: 804-282-9100
  • Fax: 804-282-3266

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 StateVA

VIII. Authorized Official

Name: MR. DANIEL R STEMBRIDGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-282-9100