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General NPI Number Information
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NPI Number | 1801100862
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Entity Type | Organization
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Legal Business Name | TEAM COUNSELING AND PSYCHOLOGICAL SERVICES, INCORPORATED
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Dates
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Enumeration Date | 08/02/2010
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Last Update Date | 08/02/2010
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Provider Practice Location Address
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Address Line | 10712 TOSTON LN
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6496
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Country | US
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Telephone | 804-967-0936
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Fax | 804-967-2151
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Provider Business Mailing Address
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Address Line | 10712 TOSTON LN
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City | GLEN ALLEN
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State | VA
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Zip | 23060-6496
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Country | US
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Telephone | 804-967-0936
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Fax | 804-967-2151
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. CHARLYNN PHILLIS SMALL
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Credential | PHD
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Telephone | 804-967-0936
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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 | 0810004046
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License Number State | VA
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