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General NPI Number Information
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NPI Number | 1043376866
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Entity Type | Organization
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Legal Business Name | FAMILY COUNSELING CENTER FOR RECOVERY
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 09/26/2014
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Provider Practice Location Address
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Address Line | 4906 RADFORD AVE
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City | RICHMOND
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State | VA
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Zip | 23230-3512
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Country | US
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Telephone | 804-354-1996
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Fax | 804-354-5516
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Provider Business Mailing Address
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Address Line | 4906 RADFORD AVE
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City | RICHMOND
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State | VA
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Zip | 23230-3512
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Country | US
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Telephone | 804-354-1996
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Fax | 804-354-5516
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHARLES ADCOCK
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Credential | LCSW
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Telephone | 804-354-1996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number | 746
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 746
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License Number State | VA
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