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General NPI Number Information
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NPI Number | 1629485115
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Entity Type | Organization
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Legal Business Name | NORTHERN NECK LIFE CONSULTANTS, PLLC
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 25 OFFICE PARK DR STE 2
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City | KILMARNOCK
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State | VA
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Zip | 22482-2805
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Country | US
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Telephone | 804-356-3008
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 607
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City | KILMARNOCK
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State | VA
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Zip | 22482-0607
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ALBERT LEONIDAS ARCHARD
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Credential | LCSW
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Telephone | 804-356-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904005207
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License Number State | VA
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