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General NPI Number Information
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NPI Number | 1962743153
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Entity Type | Organization
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Legal Business Name | CHESTNUT CREEK COUNSELING CENTER
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Dates
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Enumeration Date | 03/13/2013
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 210 CALHOUN ST
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City | GALAX
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State | VA
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Zip | 24333-3806
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Country | US
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Telephone | 276-238-1301
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Fax | 276-238-1302
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Provider Business Mailing Address
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Address Line | 210 CALHOUN ST
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City | GALAX
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State | VA
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Zip | 24333-3806
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Country | US
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Telephone | 276-238-1301
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Fax | 276-238-1302
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | SANDRA L VENZIE
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Credential | LPC
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Telephone | 276-768-8869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 0701004487
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License Number State | VA
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