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General NPI Number Information
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NPI Number | 1992618755
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Entity Type | Organization
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Legal Business Name | HEART OF VIRGINIA SUPPORTIVE SERVICES, LLC
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 10106 KRAUSE RD STE 202
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6503
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Country | US
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Telephone | 202-469-9095
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Fax | 804-800-2284
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Provider Business Mailing Address
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Address Line | 10106 KRAUSE RD STE 202
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City | CHESTERFIELD
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State | VA
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Zip | 23832-6503
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Country | US
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Telephone | 202-469-9095
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Fax | 804-800-2284
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Authorized Official
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Title or Position | OWNER
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Name | MARQUIS CLARKE
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Credential | LCSW-S
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Telephone | 202-469-9095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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