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General NPI Number Information
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NPI Number | 1588086177
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Entity Type | Organization
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Legal Business Name | SELF ACTUALIZATION COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 3500 VIRGINIA BEACH BLVD SUITE 210
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4445
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Country | US
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Telephone | 757-233-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 3500 VIRGINIA BEACH BLVD SUITE 210
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-4445
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Country | US
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Telephone | 757-233-1900
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MRS. RONEIKO HENDERSON-BEASLEY
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Credential | LCSW
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Telephone | 757-287-4990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 0904008490
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License Number State | VA
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