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General NPI Number Information
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NPI Number | 1225517642
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Entity Type | Organization
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Legal Business Name | AGEWELL COUNSELING LLC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 5529 SNEAD RD
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City | RICHMOND
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State | VA
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Zip | 23224-6038
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Country | US
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Telephone | 804-840-2623
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5192
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-0020
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Country | US
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Telephone | 804-840-2623
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Fax |
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Authorized Official
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Title or Position | OWNER/LICENSED CLINICAL SOCIAL WORK
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Name | MS. TERRIE LYNN PENDLETON
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Credential | LCSW
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Telephone | 804-840-2623
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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 | 0904004927
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License Number State | VA
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