Healthcare Provider Details

I. General information

NPI: 1083594741
Provider Name (Legal Business Name): COUNSEL CULTURE HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 PARK AVE
RICHMOND VA
23223-4817
US

IV. Provider business mailing address

508 PARK AVE
RICHMOND VA
23223-4817
US

V. Phone/Fax

Practice location:
  • Phone: 804-636-3338
  • Fax:
Mailing address:
  • Phone: 804-636-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TRAVIS JEFFRIES
Title or Position: OWNER/MANAGER
Credential:
Phone: 804-908-3019