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General NPI Number Information
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NPI Number | 1114438702
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Entity Type | Organization
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Legal Business Name | BEACH LIFE COUNSELING & CONSULTING SERVICES, PLLC
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Dates
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Enumeration Date | 10/23/2017
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Last Update Date | 10/23/2017
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Provider Practice Location Address
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Address Line | 576 N BIRDNECK RD STE 631
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6374
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Country | US
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Telephone | 757-837-2483
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Fax |
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Provider Business Mailing Address
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Address Line | 576 N BIRDNECK RD STE 631
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6374
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Country | US
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Telephone | 757-837-2483
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Fax |
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Authorized Official
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Title or Position | OWNER - PRIVATE PRACTICE COUNSELING
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Name | JAYNE CARRELS-ZELLER
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Credential | MS, LPC, NCC
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Telephone | 757-837-2483
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6608-125
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701004811
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License Number State | VA
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