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General NPI Number Information
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NPI Number | 1104255678
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Entity Type | Organization
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Legal Business Name | ATHALIA EASON, LLC
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Dates
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Enumeration Date | 11/05/2013
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Last Update Date | 02/25/2014
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Provider Practice Location Address
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Address Line | 1900 BYRD AVE SUITE 204
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City | RICHMOND
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State | VA
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Zip | 23230-3033
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Country | US
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Telephone | 540-656-3662
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Fax |
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Provider Business Mailing Address
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Address Line | 5365 DICKERSON RD
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City | PARTLOW
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State | VA
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Zip | 22534-9609
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Country | US
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Telephone | 540-656-3662
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ATHALIA EASON
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Credential | LPC, CRC
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Telephone | 540-656-3662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0701005618
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0701005618
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701005618
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701005618
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License Number State | VA
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