Healthcare Provider Details

I. General information

NPI: 1245070952
Provider Name (Legal Business Name): CONNECTED COMMUNITIES COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/31/2024
Certification Date: 05/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2654 VALLEY AVE STE G-1
WINCHESTER VA
22601-2661
US

IV. Provider business mailing address

2654 VALLEY AVE STE G-1
WINCHESTER VA
22601-2661
US

V. Phone/Fax

Practice location:
  • Phone: 540-931-1335
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TAVAN MAIR
Title or Position: OWNER
Credential:
Phone: 540-227-4948