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General NPI Number Information
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NPI Number | 1063669414
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC IN HOME COUNSELING
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 11/20/2009
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Provider Practice Location Address
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Address Line | 1949 VESONDER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-2933
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Country | US
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Telephone | 804-640-2101
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Fax | 877-879-6336
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Provider Business Mailing Address
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Address Line | 1949 VESONDER RD
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City | PETERSBURG
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State | VA
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Zip | 23805-2933
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Country | US
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Telephone | 804-722-1185
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Fax | 877-879-6336
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Authorized Official
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Title or Position | HOUSE SUPERVISOR
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Name | MISS LISA SMITH
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Credential |
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Telephone | 804-640-2101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1261
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License Number State | VA
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