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General NPI Number Information
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NPI Number | 1073932604
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Entity Type | Organization
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Legal Business Name | BEHAVIORAL & COUNSELING SERVICES OF HANOVER, LLC
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Dates
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Enumeration Date | 04/10/2014
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 9044 MANN DR
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-2312
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Country | US
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Telephone | 804-647-9802
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Fax | 804-746-5150
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Provider Business Mailing Address
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Address Line | PO BOX 3372
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City | MECHANICSVILLE
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State | VA
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Zip | 23116-0032
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Country | US
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Telephone | 804-647-9802
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Fax | 804-746-5150
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | MRS. JENNIFER G DIEHL
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Credential | LCSW
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Telephone | 804-647-9802
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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 | 0904004730
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License Number State | VA
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