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General NPI Number Information
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NPI Number | 1093067811
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Entity Type | Organization
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Legal Business Name | COUNSELING MINISTRY OF CHARLOTTESVILLE
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Dates
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Enumeration Date | 10/03/2012
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Last Update Date | 10/03/2012
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Provider Practice Location Address
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Address Line | 400 RUGBY RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-1872
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Country | US
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Telephone | 434-987-6097
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Fax |
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Provider Business Mailing Address
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Address Line | 602 BIG OAK RD
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-9730
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Country | US
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Telephone | 434-987-6097
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Fax |
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Authorized Official
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Title or Position | FOUNDER/DIRECTOR
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Name | DIANA C. BRAWLEY
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Credential | LCSW, MDIV, THM,
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Telephone | 434-987-6097
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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 | 0904006874
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License Number State | VA
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