MEDICARE: ALLIANCE FAMILY COUNSELING GROUP

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	101YM0800X	Mental Health Counselor
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1649612029
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLIANCE FAMILY COUNSELING GROUP

Provider Business Mailing Address
First Line	:	9409 HULL STREET RD STE F2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1200
Country	:	US
Telephone Number	:	804-745-1203
Fax Number	:	804-477-7828

Provider Business Practice Location Address
First Line	:	9409 HULL STREET RD STE F2
Second Line	:
City	:	NORTH CHESTERFIELD
State	:	VA
Zip	:	23236-1200
Country	:	US
Telephone Number	:	804-477-7691
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SYNTHIA LEE LAWTON
Credential	:	LCSW
Telephone Number	:	804-477-7691

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	11/26/2024

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