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General NPI Number Information
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NPI Number | 1538852462
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Entity Type | Organization
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Legal Business Name | CENTER FOR WISE COUNSEL, LLC
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Dates
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Enumeration Date | 05/26/2023
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 12849 GALVESTON CT # 120
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City | MANASSAS
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State | VA
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Zip | 20112-8676
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Country | US
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Telephone | 571-545-0592
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Fax | 855-955-1268
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Provider Business Mailing Address
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Address Line | 12849 GALVESTON CT # 120
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City | MANASSAS
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State | VA
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Zip | 20112-8676
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Country | US
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Telephone | 571-545-0592
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SHERRY A C JACKSON
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Credential | LPC, LSATP, MAC,CSAC
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Telephone | 571-545-0592
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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 | 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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Taxonomy #4
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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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