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General NPI Number Information
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NPI Number | 1649095654
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Entity Type | Organization
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Legal Business Name | LUCID LIVING COUNSELING
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Dates
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Enumeration Date | 11/15/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 6350 CENTER DR STE 102
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City | NORFOLK
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State | VA
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Zip | 23502-4107
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Country | US
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Telephone | 309-838-0152
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Fax |
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Provider Business Mailing Address
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Address Line | 6312 BUCKNELL CIR
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City | VIRGINIA BEACH
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State | VA
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Zip | 23464-4420
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Country | US
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Telephone | 309-838-0152
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BETHANY NICOLE DONOVAN
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Credential | LPC
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Telephone | 309-838-0152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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