Provider Demographics
NPI:1497122105
Name:GEORGE ENNELS, COUNSELING AND CONSULTING SERVICES, LLC
Entity Type:Organization
Organization Name:GEORGE ENNELS, COUNSELING AND CONSULTING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ENNELS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:757-439-9026
Mailing Address - Street 1:905 MERRIMAC AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-4058
Mailing Address - Country:US
Mailing Address - Phone:757-439-9026
Mailing Address - Fax:757-622-8585
Practice Address - Street 1:2412 E VIRGINIA BEACH BLVD STE D
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3604
Practice Address - Country:US
Practice Address - Phone:757-439-9026
Practice Address - Fax:757-622-8585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-28
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904000980251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164595443OtherINDIVIDUAL