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General NPI Number Information
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NPI Number | 1760789200
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Entity Type | Organization
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Legal Business Name | EXTREME COUNSELING SOLUTIONS
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 811 LOGAN ST
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City | PETERSBURG
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State | VA
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Zip | 23803-3329
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Country | US
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Telephone | 804-382-0098
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Fax |
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Provider Business Mailing Address
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Address Line | 811 LOGAN ST
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City | PETERSBURG
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State | VA
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Zip | 23803-3329
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Country | US
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Telephone | 804-382-0098
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DEATRICE DENISE DELK
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Credential | M.ED.
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Telephone | 804-382-0098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1394
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License Number State | VA
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