Healthcare Provider Details

I. General information

NPI: 1952085961
Provider Name (Legal Business Name): ACW COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 01/04/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1435 OLD OAK ARCH
VIRGINIA BEACH VA
23453-1924
US

IV. Provider business mailing address

1435 OLD OAK ARCH
VIRGINIA BEACH VA
23453-1924
US

V. Phone/Fax

Practice location:
  • Phone: 757-748-9298
  • Fax:
Mailing address:
  • Phone: 757-748-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ABRIAN NICOLE WIGGINS
Title or Position: DIRECTOR
Credential: LPC
Phone: 757-748-9298