Provider Demographics
NPI:1093067811
Name:COUNSELING MINISTRY OF CHARLOTTESVILLE
Entity Type:Organization
Organization Name:COUNSELING MINISTRY OF CHARLOTTESVILLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MDIV, THM,
Authorized Official - Phone:434-987-6097
Mailing Address - Street 1:602 BIG OAK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-9730
Mailing Address - Country:US
Mailing Address - Phone:434-987-6097
Mailing Address - Fax:
Practice Address - Street 1:400 RUGBY RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-1872
Practice Address - Country:US
Practice Address - Phone:434-987-6097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040068741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty