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General NPI Number Information
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NPI Number | 1760789317
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Entity Type | Organization
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Legal Business Name | CONCORD COUNSELING & CONSULTING, LLC
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 02/17/2015
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Provider Practice Location Address
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Address Line | 500 MONTGOMERY ST SUITE 400
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City | ALEXANDRIA
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State | VA
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Zip | 22314-1565
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Country | US
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Telephone | 703-969-6066
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6203
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City | LARGO
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State | MD
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Zip | 20792-6203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TANISHA HOLMES
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Credential | LPC, CEAP, SAP
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Telephone | 703-969-6066
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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 | 0701005911
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License Number State | VA
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