Provider Demographics
NPI:1407457807
Name:COLLABORATIVE POINT COUNSELING & CONSULTING
Entity Type:Organization
Organization Name:COLLABORATIVE POINT COUNSELING & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DORCILLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LSATP, CRC
Authorized Official - Phone:804-479-2862
Mailing Address - Street 1:PO BOX 42302
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23242-2302
Mailing Address - Country:US
Mailing Address - Phone:804-537-0170
Mailing Address - Fax:
Practice Address - Street 1:10509 PATTERSON AVE # 42302
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-5103
Practice Address - Country:US
Practice Address - Phone:804-537-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1710467790OtherINDIVIDUAL NPI