Provider Demographics
NPI:1083287676
Name:THAT COUNSELING PLACE, LLC
Entity Type:Organization
Organization Name:THAT COUNSELING PLACE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SELINA
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-944-4994
Mailing Address - Street 1:PO BOX 6605
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24068-6605
Mailing Address - Country:US
Mailing Address - Phone:540-944-4994
Mailing Address - Fax:540-944-6446
Practice Address - Street 1:930 CAMBRIA ST NE STE 100
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1631
Practice Address - Country:US
Practice Address - Phone:540-944-4994
Practice Address - Fax:540-944-6446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023505047Medicaid
1023505047OtherNPI