MEDICARE: LIDER COUNSELING, 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

General Provider Information

NPI Number	:	1609289479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIDER COUNSELING, LLC

Provider Business Mailing Address
First Line	:	3509 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4421
Country	:	US
Telephone Number	:	804-905-8067
Fax Number	:	757-538-7902

Provider Business Practice Location Address
First Line	:	3509 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-4421
Country	:	US
Telephone Number	:	804-905-8067
Fax Number	:	757-538-7902

Authorized Official
Title or Position	:	OWNER/CLINICIAN
Name	:	ALFRED HOWARD
Credential	:	LCSW
Telephone Number	:	804-905-8067

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	03/12/2024

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