Provider Demographics
NPI:1073932604
Name:BEHAVIORAL & COUNSELING SERVICES OF HANOVER, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL & COUNSELING SERVICES OF HANOVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:G
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-647-9802
Mailing Address - Street 1:PO BOX 3372
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-0032
Mailing Address - Country:US
Mailing Address - Phone:804-647-9802
Mailing Address - Fax:804-746-5150
Practice Address - Street 1:9044 MANN DR
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2312
Practice Address - Country:US
Practice Address - Phone:804-647-9802
Practice Address - Fax:804-746-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040047301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty