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General NPI Number Information
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NPI Number | 1720809957
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Entity Type | Organization
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Legal Business Name | BOUND 2 CONNECT MINISTRIES, INC.
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Dates
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Enumeration Date | 10/21/2024
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Last Update Date | 10/21/2024
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Provider Practice Location Address
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Address Line | 152 SECRETARIAT DR
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City | SUFFOLK
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State | VA
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Zip | 23435-1786
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Country | US
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Telephone | 757-660-0515
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Fax |
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Provider Business Mailing Address
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Address Line | 152 SECRETARIAT DR
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City | SUFFOLK
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State | VA
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Zip | 23435-1786
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Country | US
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Telephone | 757-660-0515
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | REKITA DANYALLE NELSON
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Credential | LPC, LPASTC
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Telephone | 757-660-0515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number |
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License Number State |
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