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General NPI Number Information
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NPI Number | 1972278323
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Entity Type | Organization
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Legal Business Name | COLOR PURPLE COUNSELING LLC
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 2 LAFAYETTE ST
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City | STAFFORD
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State | VA
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Zip | 22554-7699
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Country | US
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Telephone | 540-658-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 2769 JEFFERSON DAVIS HWY STE 111
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City | STAFFORD
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State | VA
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Zip | 22554-8326
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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 | OWNER
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Name | SHAKOYA HICKS
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Credential |
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Telephone | 540-226-5733
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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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