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General NPI Number Information
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NPI Number | 1962379917
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Entity Type | Organization
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Legal Business Name | TRAILMARKER CLINICAL GROUP LLC
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Dates
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Enumeration Date | 10/22/2025
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 11709 RUTGERS DR
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City | HENRICO
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State | VA
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Zip | 23233-1697
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Country | US
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Telephone | 540-840-5346
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Fax |
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Provider Business Mailing Address
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Address Line | 6841 FOREST HILL AVE UNIT 560
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City | RICHMOND
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State | VA
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Zip | 23225-1603
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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 | CLINICAL DIRECTOR
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Name | ERIC LAVALLE
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Credential | MSED, LPC, NCC
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Telephone | 540-300-5954
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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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