MEDICARE: EMERALD COUNSELING GROUP 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	:	1306784699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMERALD COUNSELING GROUP LLC

Provider Business Mailing Address
First Line	:	6353 BROAD SKY CIR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-4630
Country	:	US
Telephone Number	:	804-840-5414
Fax Number	:

Provider Business Practice Location Address
First Line	:	6353 BROAD SKY CIR
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23111-4630
Country	:	US
Telephone Number	:	804-840-5414
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	CHELSEA RAYNE VICARIO
Credential	:
Telephone Number	:	804-840-5414

Provider Enumeration Date	:	03/25/2026
Last Update Date	:	03/26/2026

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