Healthcare Provider Details

I. General information

NPI: 1003924812
Provider Name (Legal Business Name): BEACON COUNSELING AND CONSULTING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 11/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 MCLAWS CIRCLE, SUITE 2
WILLIAMSBURG VA
23011
US

IV. Provider business mailing address

BEACON COUNSELING AND CONSULTING PC 372 MCLAWS CIRCLE, SUITE 2
WILLIAMSBURG VA
23185
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-3100
  • Fax: 757-564-3500
Mailing address:
  • Phone: 757-564-3100
  • Fax: 757-564-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. MELANIE D. KING
Title or Position: OFFICE MANAGER
Credential:
Phone: 757-564-3100