=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710708854
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIND COURAGE THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2024
-----------------------------------------------------
Last Update Date | 10/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 FRANKLIN ST FL 2
-----------------------------------------------------
City | HARRISONBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22801-4017
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-818-1170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 440 MONTICELLO AVE STE 1802 PMB 622678
-----------------------------------------------------
City | NORFOLK
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23510-2670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-818-1170
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL SOCIAL WORKER
-----------------------------------------------------
Name | CHELSEA SPADE
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 240-818-1170
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------