Healthcare Provider Details

I. General information

NPI: 1467068122
Provider Name (Legal Business Name): CACAPON COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/06/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 S CAMERON ST
WINCHESTER VA
22601-4603
US

IV. Provider business mailing address

38 CHEROKEE TRL
BERKELEY SPRINGS WV
25411-7371
US

V. Phone/Fax

Practice location:
  • Phone: 845-242-1084
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KRISTY-ANN COOK
Title or Position: CLINICIAN/OWNER
Credential: LCSW
Phone: 845-242-1084