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General NPI Number Information
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NPI Number | 1790152775
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Entity Type | Organization
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Legal Business Name | FAMILY COUNSELING CENTER FOR RECOVERY
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 905 SOUTHLAKE BLVD STE C
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3955
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Country | US
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Telephone | 804-419-0492
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Fax | 804-419-0500
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Provider Business Mailing Address
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Address Line | 905 SOUTHLAKE BLVD STE C
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City | NORTH CHESTERFIELD
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State | VA
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Zip | 23236-3955
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Country | US
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Telephone | 804-419-0492
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Fax | 804-419-0500
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | MR. CHARLES ADCOCK
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Credential | LCSW
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Telephone | 540-735-9350
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 0701006241
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License Number State | VA
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