Provider Demographics
NPI:1417455031
Name:CLINICAL COUNSELING AND CONSULTING OF VIRGINIA PLLC
Entity Type:Organization
Organization Name:CLINICAL COUNSELING AND CONSULTING OF VIRGINIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-562-6527
Mailing Address - Street 1:4110 E PARHAM RD STE 208
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23228-2754
Mailing Address - Country:US
Mailing Address - Phone:804-562-6527
Mailing Address - Fax:
Practice Address - Street 1:4110 E PARHAM RD STE 208
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23228-2754
Practice Address - Country:US
Practice Address - Phone:804-562-6527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904010195101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty