Provider Demographics
NPI:1114489317
Name:THERAPEUTIC LEARNING CONSORTIUM LLC
Entity Type:Organization
Organization Name:THERAPEUTIC LEARNING CONSORTIUM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TREVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLCLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:803-795-8604
Mailing Address - Street 1:8154 FOREST HILL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3255
Mailing Address - Country:US
Mailing Address - Phone:804-234-3350
Mailing Address - Fax:804-533-1459
Practice Address - Street 1:8154 FOREST HILL AVE STE 2
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235
Practice Address - Country:US
Practice Address - Phone:804-234-3350
Practice Address - Fax:804-533-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-05
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)