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General NPI Number Information
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NPI Number | 1639566789
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Entity Type | Organization
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Legal Business Name | INTERCEDING CONSULTANT LLC
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Dates
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Enumeration Date | 04/15/2015
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 5412 GLENSIDE DR STE F
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City | RICHMOND
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State | VA
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Zip | 23228-3995
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Country | US
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Telephone | 804-997-7962
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Fax | 877-333-0229
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Provider Business Mailing Address
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Address Line | 1140 WILKINSON RD
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City | RICHMOND
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State | VA
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Zip | 23227-1623
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Country | US
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Telephone | 804-997-7962
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Fax | 877-333-0229
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Authorized Official
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Title or Position | CEO
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Name | EDWARD TILLMAN
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Credential |
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Telephone | 804-301-6410
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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