MEDICARE: BEACH COUNSELING CENTER 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	1041C0700X	Clinical Social Worker	0904009182	VA
2	101YP2500X	Professional Counselor	0701004521	VA

General Provider Information

NPI Number	:	1336510254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACH COUNSELING CENTER LLC

Provider Business Mailing Address
First Line	:	817 LINKHORN DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-3920
Country	:	US
Telephone Number	:	757-651-3003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1064 LASKIN RD STE 14C
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6337
Country	:	US
Telephone Number	:	757-233-1500
Fax Number	:	757-222-3833

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	LOU PHILLIPS
Credential	:
Telephone Number	:	757-651-3003

Provider Enumeration Date	:	10/19/2015
Last Update Date	:	07/14/2023

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