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NPI Code Detail

MEDICARE: CJ COUNSELING AND CONSULTING SERVICES, LLC

MEDICARE: CJ COUNSELING AND CONSULTING SERVICES, 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
11041C0700XClinical Social Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11245666288OTHERVANPI

General Provider Information

NPI Number : 1952862831
Entity Type Code : Organization
Provider Name (Legal Business Name) : CJ COUNSELING AND CONSULTING SERVICES, LLC
Provider Business Mailing Address
First Line : 500 WASHINGTON ST STE A
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23704-3508
Country : US
Telephone Number : 757-613-8801
Fax Number :
Provider Business Practice Location Address
First Line : 500 WASHINGTON ST STE A
Second Line :
City : PORTSMOUTH
State : VA
Zip : 23704-3508
Country : US
Telephone Number : 757-613-8801
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. CHARESE LAKISA JOSIE
Credential : LCSW
Telephone Number : 757-613-8801
Provider Enumeration Date : 03/25/2019
Last Update Date : 07/08/2019

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