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General NPI Number Information
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NPI Number | 1760309322
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Entity Type | Organization
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Legal Business Name | MODERN TRAUMA AND EMDR COUNSELING, PLLC
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Dates
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Enumeration Date | 07/02/2026
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Last Update Date | 07/02/2026
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Provider Practice Location Address
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Address Line | 315 KENT LN
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City | KENTS STORE
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State | VA
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Zip | 23084-2269
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Country | US
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Telephone | 609-969-3009
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Fax |
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Provider Business Mailing Address
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Address Line | 315 KENT LN
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City | KENTS STORE
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State | VA
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Zip | 23084-2269
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Country | US
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Telephone | 609-969-3009
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACEY DAMKOHLER
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Credential | LPC, LCMHC, LMHC
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Telephone | 732-475-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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