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General NPI Number Information
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NPI Number | 1568258861
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Entity Type | Organization
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Legal Business Name | SELF-EVOLUTION COUNSELING & CLINICAL CONSULTATION, LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 700 E 6TH ST # L
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City | RICHMOND
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State | VA
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Zip | 23224-5560
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Country | US
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Telephone | 804-252-1862
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Fax | 804-655-6171
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Provider Business Mailing Address
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Address Line | 700 E 6TH ST # L
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City | RICHMOND
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State | VA
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Zip | 23224-5560
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Country | US
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Telephone | 804-252-1862
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Fax | 804-655-6171
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Authorized Official
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Title or Position | LPC/OWNER
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Name | ANDREA RENEA GREGG-MARTIN
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Credential | MA, LPC, LMHP
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Telephone | 804-252-1862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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