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General NPI Number Information
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NPI Number | 1700550621
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Entity Type | Organization
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Legal Business Name | IMPACT COACHING CONSULTING AND COUNSELING CENTER LLC
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 1914 BEAVER RD
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City | HIGHLAND SPRINGS
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State | VA
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Zip | 23075-2404
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Country | US
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Telephone | 804-243-4939
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Fax |
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Provider Business Mailing Address
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Address Line | 1248 CARMIA WAY # 1053
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23235-4750
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Country | US
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Telephone | 804-243-4939
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIATHE GARNES
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Credential | MS, QMHP-A,C
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Telephone | 804-243-4939
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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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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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