Healthcare Provider Details

I. General information

NPI: 1043376866
Provider Name (Legal Business Name): FAMILY COUNSELING CENTER FOR RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 09/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 RADFORD AVE
RICHMOND VA
23230-3512
US

IV. Provider business mailing address

4906 RADFORD AVE
RICHMOND VA
23230-3512
US

V. Phone/Fax

Practice location:
  • Phone: 804-354-1996
  • Fax: 804-354-5516
Mailing address:
  • Phone: 804-354-1996
  • Fax: 804-354-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2800X
TaxonomyMethadone Clinic
License Number746
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number746
License Number StateVA

VIII. Authorized Official

Name: CHARLES ADCOCK
Title or Position: DIRECTOR
Credential: LCSW
Phone: 804-354-1996