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General NPI Number Information
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NPI Number | 1740780345
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Entity Type | Organization
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Legal Business Name | GOOD MOURNING COUNSELING & CONSULTING LLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 3630 S PLAZA TRL STE 210C
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City | VIRGINIA BEACH
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State | VA
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Zip | 23452-3366
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Country | US
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Telephone | 757-572-4609
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 DEBBS LN
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City | CHESAPEAKE
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State | VA
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Zip | 23320-8202
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Country | US
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Telephone | 757-436-4368
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/COUNSELOR
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Name | MRS. ANISA GLOWCZAK
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Credential | MSED, LPC, NCC-GC-C
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Telephone | 757-572-4609
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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 | 0701007162
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License Number State | VA
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