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General NPI Number Information
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NPI Number | 1497122105
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Entity Type | Organization
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Legal Business Name | GEORGE ENNELS, COUNSELING AND CONSULTING SERVICES, LLC
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Dates
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Enumeration Date | 08/28/2015
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 2412 E VIRGINIA BEACH BLVD STE D
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City | NORFOLK
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State | VA
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Zip | 23504-3604
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Country | US
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Telephone | 757-439-9026
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Fax | 757-622-8585
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Provider Business Mailing Address
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Address Line | 905 MERRIMAC AVE
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City | NORFOLK
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State | VA
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Zip | 23504-4058
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Country | US
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Telephone | 757-439-9026
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Fax | 757-622-8585
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MR. GEORGE MICHAEL ENNELS
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Credential | LCSW
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Telephone | 757-439-9026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0904000980
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License Number State | VA
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