Provider Demographics
NPI:1407400203
Name:360 COUNSELING & SERVICES
Entity Type:Organization
Organization Name:360 COUNSELING & SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-898-4840
Mailing Address - Street 1:5509 TOWNSBURY TERRRACE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9256
Mailing Address - Country:US
Mailing Address - Phone:804-898-4840
Mailing Address - Fax:
Practice Address - Street 1:5509 TOWNSBURY TERRRACE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-9256
Practice Address - Country:US
Practice Address - Phone:804-898-4840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health