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General NPI Number Information
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NPI Number | 1104283191
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Entity Type | Organization
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Legal Business Name | SOARING FOR CHANGE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/21/2016
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Last Update Date | 01/21/2016
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Provider Practice Location Address
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Address Line | 3320 PLOWFIELD CT
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City | RICHMOND
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State | VA
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Zip | 23223-1272
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Country | US
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Telephone | 804-683-8731
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Fax | 804-225-8688
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Provider Business Mailing Address
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Address Line | 3320 PLOWFIELD CT
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City | RICHMOND
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State | VA
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Zip | 23223-1272
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Country | US
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Telephone | 804-683-8731
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Fax | 804-225-8688
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. RASHA NICKERA HICKS
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Credential | LPC
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Telephone | 804-683-8731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0701006414
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License Number State | VA
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