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General NPI Number Information
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NPI Number | 1760709778
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Entity Type | Individual
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Provider Name | MENZO LEE FAASSEN LPCC
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Gender | Male
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Dates
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Enumeration Date | 04/29/2010
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Last Update Date | 05/02/2024
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Provider Practice Location Address
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Address Line | 7702 E PARHAM RD STE 205
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City | RICHMOND
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State | VA
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Zip | 23294-4374
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Country | US
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Telephone | 804-747-5674
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 SEMMES AVE APT 411
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City | RICHMOND
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State | VA
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Zip | 23224-2184
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Country | US
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Telephone | 615-734-9969
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | CCMH0201241
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701010945
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License Number State | VA
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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 | 3360
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License Number State | TN
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