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General NPI Number Information
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NPI Number | 1598900482
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Entity Type | Organization
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Legal Business Name | COUNSELING AND ADVOCACY ASSC.
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Dates
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Enumeration Date | 12/08/2008
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 10128 HULL STREET RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112
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Country | US
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Telephone | 804-744-1114
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Fax | 804-893-3721
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Provider Business Mailing Address
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Address Line | 10128 HULL STREET RD
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-3300
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Country | US
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Telephone | 804-744-1114
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Fax | 804-893-3721
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Authorized Official
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Title or Position | OWN/PROGRAM DIRECTOR
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Name | WENDY DEMARZIO
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Credential | LCSW
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Telephone | 804-426-1419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1175--05-001
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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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 | 1175-05-01
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License Number State | VA
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