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General NPI Number Information
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NPI Number | 1912899758
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Entity Type | Organization
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Legal Business Name | EVERGLOW COUNSELING COLLECTIVE, LLC
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 6615 W MAIN ST
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City | WISE
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State | VA
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Zip | 24293-7115
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Country | US
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Telephone | 276-207-8316
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Fax |
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Provider Business Mailing Address
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Address Line | 1069 CROOKED BR
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City | HAYSI
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State | VA
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Zip | 24256-5108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MARIANNA SKIDMORE
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Credential | LPC
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Telephone | 276-220-0731
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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