MEDICARE: DYNASTY COUNSELING SERVICES

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	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1023658242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNASTY COUNSELING SERVICES

Provider Business Mailing Address
First Line	:	2807 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4410
Country	:	US
Telephone Number	:	804-426-3405
Fax Number	:

Provider Business Practice Location Address
First Line	:	2807 N PARHAM RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23294-4410
Country	:	US
Telephone Number	:	804-426-3405
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. TREVON KEONTE BURCH
Credential	:	B.S. QMHP
Telephone Number	:	804-426-3405

Provider Enumeration Date	:	01/15/2020
Last Update Date	:	11/10/2024

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