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General NPI Number Information
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NPI Number | 1013348598
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Entity Type | Organization
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Legal Business Name | BALANCE COUNSELING, LLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 9409 HULL STREET RD SUITE D1
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1200
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Country | US
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Telephone | 804-745-2225
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Fax | 804-745-2242
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Provider Business Mailing Address
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Address Line | 9409 HULL STREET RD SUITE D1
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-1200
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Country | US
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Telephone | 804-745-2225
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Fax | 804-745-2242
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Authorized Official
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Title or Position | OWNER
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Name | LICIA THOMAS-WAGONER
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Credential | LCSW
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Telephone | 804-745-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904006772
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License Number State | VA
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