Healthcare Provider Details

I. General information

NPI: 1740647700
Provider Name (Legal Business Name): TLCOUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2016
Last Update Date: 01/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4509 WHITECHAPEL DR
VIRGINIA BEACH VA
23455-6447
US

IV. Provider business mailing address

2220 KIRKBY LN
VIRGINIA BEACH VA
23456-6975
US

V. Phone/Fax

Practice location:
  • Phone: 757-460-4655
  • Fax:
Mailing address:
  • Phone: 703-980-9205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701003802
License Number StateVA

VIII. Authorized Official

Name: KRISTINE U LARSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: LPC
Phone: 703-980-9205