=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497514368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 3 DIMENSIONS COUNSELING SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2024
-----------------------------------------------------
Last Update Date | 03/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3287 S CRATER RD
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23805-9216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-835-4242
-----------------------------------------------------
Fax | 804-324-5487
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1904
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23805-0904
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-835-4242
-----------------------------------------------------
Fax | 804-324-5487
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. ODESSA BRITTENUM
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 804-835-4242
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------