=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659578870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POWHATAN FAMILY COUNSELING AND EDUCATION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/29/2007
-----------------------------------------------------
Last Update Date | 04/13/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2156 PLAINVIEW CENTER
-----------------------------------------------------
City | POWHATAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-598-9577
-----------------------------------------------------
Fax | 804-598-0086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2156 PLAINVIEW CENTER
-----------------------------------------------------
City | POWHATAN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-598-9577
-----------------------------------------------------
Fax | 804-598-0086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BOOKKEEPER
-----------------------------------------------------
Name | MRS. BARBARA L BRIDGES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 804-598-9577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 0810000169
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------