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General NPI Number Information
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NPI Number | 1619525763
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Entity Type | Organization
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Legal Business Name | ESSENTIAL REFLECTIONS COUNSELING AND CONSULTATION, LLC
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Dates
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Enumeration Date | 09/02/2019
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Last Update Date | 09/25/2019
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Provider Practice Location Address
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Address Line | 4130 LINDEN AVE STE 320
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City | DAYTON
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State | OH
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Zip | 45432-3034
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Country | US
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Telephone | 937-603-7746
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Fax |
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Provider Business Mailing Address
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Address Line | 4130 LINDEN AVE STE 320
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City | DAYTON
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State | OH
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Zip | 45432-3034
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Country | US
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Telephone | 937-603-7746
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREA BANKS RAIMEY
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Credential | LISW-S
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Telephone | 937-550-8996
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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