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General NPI Number Information
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NPI Number | 1477563492
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Entity Type | Organization
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Legal Business Name | LIFE CONSTRUCTION MENTAL HEALTH SERVICES
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 06/18/2008
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Provider Practice Location Address
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Address Line | 3105 W MARSHALL ST SUITE 114
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City | RICHMOND
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State | VA
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Zip | 23230-4729
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Country | US
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Telephone | 804-359-3737
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Fax | 804-359-2266
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Provider Business Mailing Address
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Address Line | 3105 W MARSHALL ST SUITE 114
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City | RICHMOND
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State | VA
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Zip | 23230-4729
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Country | US
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Telephone | 804-359-3737
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Fax | 804-359-2266
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. EUNICE BASS GILCHRIST
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Credential | RN, BSN, MS
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Telephone | 804-359-3737
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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 | 721
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License Number State | VA
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