=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770980864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GLEN FOREST COUNSELING AND CONSULTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2014
-----------------------------------------------------
Last Update Date | 12/04/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 N PARHAM RD #206
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-6456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-467-3314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 906 N PARHAM RD #206
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23229-6456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-467-3314
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | LINDA PRIDDY SCHEPKER
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 804-467-3314
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------