MEDICARE: SJW COUNSELING AND COACHING 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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1134063274
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SJW COUNSELING AND COACHING SERVICES LLC

Provider Business Mailing Address
First Line	:	2832 S LYNNHAVEN RD STE 202
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6715
Country	:	US
Telephone Number	:	757-472-0258
Fax Number	:

Provider Business Practice Location Address
First Line	:	2832 S LYNNHAVEN RD STE 202
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-6715
Country	:	US
Telephone Number	:	757-472-0258
Fax Number	:

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	KIM RICHARDSON
Credential	:
Telephone Number	:	757-907-2567

Provider Enumeration Date	:	04/17/2026
Last Update Date	:	04/17/2026

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