Provider Demographics
NPI:1356626527
Name:COUNSELING AND PSYCHOLOGICAL SERVICES,LLC
Entity Type:Organization
Organization Name:COUNSELING AND PSYCHOLOGICAL SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GALEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIEHL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-792-2277
Mailing Address - Street 1:1045 MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1800
Mailing Address - Country:US
Mailing Address - Phone:434-792-2277
Mailing Address - Fax:434-792-2279
Practice Address - Street 1:1045 MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1800
Practice Address - Country:US
Practice Address - Phone:434-792-2277
Practice Address - Fax:434-792-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS379926-1261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)