Healthcare Provider Details

I. General information

NPI: 1912836842
Provider Name (Legal Business Name): MLCB THERAPY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 COVERDALE LN
VIRGINIA BEACH VA
23452-3942
US

IV. Provider business mailing address

808 COVERDALE LN
VIRGINIA BEACH VA
23452-3942
US

V. Phone/Fax

Practice location:
  • Phone: 703-898-9691
  • Fax:
Mailing address:
  • Phone: 703-898-9691
  • 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: MS. MEREDITH LEE BURNETT
Title or Position: THERAPIST
Credential: LPC
Phone: 703-898-9691