=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306421086
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIVA COUNSELING AND CONSULTING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2021
-----------------------------------------------------
Last Update Date | 03/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8 RESERVOIR CIR STE 105
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-6362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-250-9009
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8 RESERVOIR CIR STE 105
-----------------------------------------------------
City | PIKESVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21208-6362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-250-9008
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | KAIRO VIVAS
-----------------------------------------------------
Credential | LCSW-C, LICSW
-----------------------------------------------------
Telephone | 202-250-9008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------