=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821358656
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MSN COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2012
-----------------------------------------------------
Last Update Date | 07/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 PUMP RD SUITE 220
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-662-1676
-----------------------------------------------------
Fax | 804-918-1798
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 PUMP RD SUITE 220
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-662-1676
-----------------------------------------------------
Fax | 804-918-1798
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | THERAPIST
-----------------------------------------------------
Name | MRS. MARJORIE S NORTH
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 703-662-1676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 0904005339
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------