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General NPI Number Information
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NPI Number | 1407457807
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE POINT COUNSELING & CONSULTING
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Dates
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Enumeration Date | 11/03/2020
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Last Update Date | 11/03/2020
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Provider Practice Location Address
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Address Line | 10509 PATTERSON AVE # 42302
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City | HENRICO
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State | VA
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Zip | 23238-5103
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Country | US
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Telephone | 804-537-0170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 42302
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City | HENRICO
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State | VA
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Zip | 23242-2302
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Country | US
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Telephone | 804-537-0170
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Fax |
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Authorized Official
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Title or Position | MANAGING OWNER
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Name | MS. DORCILLE M JERNIGAN
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Credential | LPC, LSATP, CRC
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Telephone | 804-479-2862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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