MEDICARE: SOPHROSYNE COUNSELING SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1003458886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOPHROSYNE COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	4549 VAUXHALL RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3556
Country	:	US
Telephone Number	:	631-745-3778
Fax Number	:

Provider Business Practice Location Address
First Line	:	4549 VAUXHALL RD
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23234-3556
Country	:	US
Telephone Number	:	631-745-3778
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALAYSHIA PINKNEY
Credential	:	LPC, CAADC, CSAC
Telephone Number	:	631-745-3778

Provider Enumeration Date	:	10/12/2019
Last Update Date	:	10/21/2019

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