Provider Demographics
NPI:1376074476
Name:COUNSELING 1-2-1 LLC
Entity Type:Organization
Organization Name:COUNSELING 1-2-1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:716-465-1108
Mailing Address - Street 1:9200 CHURCH ST
Mailing Address - Street 2:202
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-5597
Mailing Address - Country:US
Mailing Address - Phone:716-465-1108
Mailing Address - Fax:
Practice Address - Street 1:9200 CHURCH ST
Practice Address - Street 2:202
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-5597
Practice Address - Country:US
Practice Address - Phone:716-465-1108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006204101YP2500X
MDLC7200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty