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General NPI Number Information
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NPI Number | 1205355898
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Entity Type | Organization
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Legal Business Name | TRANSFORMATION TAKES TIME COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5911 WILLOW OAKS DRIVE APT E
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City | RICHMOND
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State | VA
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Zip | 23225-2428
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Country | US
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Telephone | 804-277-7761
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Fax |
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Provider Business Mailing Address
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Address Line | 5911 WILLOW OAKS DR APT E
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City | RICHMOND
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State | VA
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Zip | 23225-2428
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Country | US
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Telephone | 804-277-7761
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Fax |
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Authorized Official
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Title or Position | LICENSED MENTAL HEALTH CLINICIAN
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Name | MR. YASIM S CLARK
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Credential | LPC, CSOTP
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Telephone | 804-277-7761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701006598
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License Number State | VA
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