Provider Demographics
NPI:1417225061
Name:COUNSELING ALLIANCE OF VA, LLC
Entity Type:Organization
Organization Name:COUNSELING ALLIANCE OF VA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASH
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-346-5165
Mailing Address - Street 1:8527 MAYLAND DR
Mailing Address - Street 2:101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4753
Mailing Address - Country:US
Mailing Address - Phone:804-346-5165
Mailing Address - Fax:804-346-5167
Practice Address - Street 1:8527 MAYLAND DR
Practice Address - Street 2:101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4753
Practice Address - Country:US
Practice Address - Phone:804-346-5165
Practice Address - Fax:804-346-5167
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUSELING ALLIANCE OF VA, LLC INTENSIVE IN HOME SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA9040068281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========Medicaid