MEDICARE: CARDINAL CARE COUNSELING

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1144069634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDINAL CARE COUNSELING

Provider Business Mailing Address
First Line	:	521 N ADAMS ST STE C
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3903
Country	:	US
Telephone Number	:	804-471-2273
Fax Number	:	804-789-2273

Provider Business Practice Location Address
First Line	:	521 N ADAMS ST STE C
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23220-3903
Country	:	US
Telephone Number	:	804-471-2273
Fax Number	:	804-789-2273

Authorized Official
Title or Position	:	CEO
Name	:	MS. ASONNA JOHNSON
Credential	:
Telephone Number	:	804-471-2273

Provider Enumeration Date	:	05/23/2024
Last Update Date	:	05/23/2024

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