=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639787799
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATIONAL CONSORTIUM FOR MENTLA HEALTH COUNSELORS (NCMHC)
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2020
-----------------------------------------------------
Last Update Date | 09/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2052 RICHMOND HWY STE 109108
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22554-7286
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-419-5498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 901
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22555-0901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-419-5498
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DOROTHY MARIE BUTTS-VALENTINE
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 540-419-5498
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------