Provider Demographics
NPI:1093282790
Name:PROMINENT COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:PROMINENT COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/QMHP
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRAIGHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-716-8908
Mailing Address - Street 1:8014 MIDLOTHIAN TPKE STE 315
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5291
Mailing Address - Country:US
Mailing Address - Phone:804-716-8908
Mailing Address - Fax:866-216-5506
Practice Address - Street 1:8014 MIDLOTHIAN TPKE STE 315
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5291
Practice Address - Country:US
Practice Address - Phone:804-716-8908
Practice Address - Fax:866-216-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health