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General NPI Number Information
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NPI Number | 1649482860
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Entity Type | Organization
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Legal Business Name | CHRYSALIS COUNSELING CENTER
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7250 GARDNER PARK DRIVE
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-753-7773
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Fax | 703-753-0723
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Provider Business Mailing Address
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Address Line | 1100 SUNSET LANE SUITE 1310A
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City | CULPEPER
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State | VA
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Zip | 22701
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Country | US
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Telephone | 540-727-0770
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Fax | 540-727-7310
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Authorized Official
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Title or Position | DIRECTOR AND CEO
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Name | MRS. ELISE STEVENSON
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Credential | LCSW
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Telephone | 540-727-0770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701003772
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License Number State | VA
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