Provider Demographics
NPI:1477296457
Name:DOCTOR MAYS-COUCH LLC
Entity Type:Organization
Organization Name:DOCTOR MAYS-COUCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYS-COUCH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-315-1817
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0032
Mailing Address - Country:US
Mailing Address - Phone:434-542-3315
Mailing Address - Fax:
Practice Address - Street 1:1839 THOMAS JEFFERESON HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURTHOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923
Practice Address - Country:US
Practice Address - Phone:434-542-3315
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty