Healthcare Provider Details

I. General information

NPI: 1336510254
Provider Name (Legal Business Name): BEACH COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1064 LASKIN RD STE 14C
VIRGINIA BEACH VA
23451-6337
US

IV. Provider business mailing address

817 LINKHORN DR
VIRGINIA BEACH VA
23451-3920
US

V. Phone/Fax

Practice location:
  • Phone: 757-233-1500
  • Fax: 757-222-3833
Mailing address:
  • Phone: 757-651-3003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004521
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009182
License Number StateVA

VIII. Authorized Official

Name: LOU PHILLIPS
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-651-3003