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General NPI Number Information
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NPI Number | 1073080420
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Entity Type | Organization
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Legal Business Name | EMORY CENTER FOR COUNSELING AND WELLNESS
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Dates
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Enumeration Date | 10/24/2018
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 1919 COMMERCE DR STE 300
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City | HAMPTON
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State | VA
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Zip | 23666-4269
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Country | US
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Telephone | 757-706-1783
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Fax |
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Provider Business Mailing Address
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Address Line | 817 27TH ST
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-4134
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Country | US
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Telephone | 757-706-1783
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MONIQUE SIMPSON
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Credential | LCSW
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Telephone | 757-706-1783
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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