MEDICARE: HEAVENLY TOUCH COUNSELING SERVICE 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	251S00000X	Community/Behavioral Health Agency		VA

General Provider Information

NPI Number	:	1932560927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEAVENLY TOUCH COUNSELING SERVICE LLC.

Provider Business Mailing Address
First Line	:	1035 GUSTAVO LN
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2356
Country	:	US
Telephone Number	:	804-490-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 GUSTAVO LN
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2356
Country	:	US
Telephone Number	:	804-490-2021
Fax Number	:

Authorized Official
Title or Position	:	CEO/ ADMINISTRATOR
Name	:	DR. ANTONIO Q ARNOLD
Credential	:	D.D., M.DIV.
Telephone Number	:	804-490-2021

Provider Enumeration Date	:	03/17/2016
Last Update Date	:	03/17/2016

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