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General NPI Number Information
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NPI Number | 1881392710
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE COMMUNITY COUNSELING, LLC
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 02/20/2023
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Provider Practice Location Address
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Address Line | 3907 AUTUMN MIST CT
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City | CHESTERFIELD
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State | VA
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Zip | 23832-8492
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Country | US
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Telephone | 804-630-0006
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Fax |
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Provider Business Mailing Address
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Address Line | 3907 AUTUMN MIST CT
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City | CHESTERFIELD
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State | VA
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Zip | 23832-8492
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Country | US
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Telephone | 804-617-1352
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DARRELL J JONES
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Credential | MA, LPC
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Telephone | 804-617-1352
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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