Provider Demographics
NPI:1629580139
Name:FIRESIDE COUNSELING LLC
Entity Type:Organization
Organization Name:FIRESIDE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:520-977-9870
Mailing Address - Street 1:7300 HANOVER GREEN DR STE 300E
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1705
Mailing Address - Country:US
Mailing Address - Phone:804-220-0036
Mailing Address - Fax:804-597-0114
Practice Address - Street 1:7300 HANOVER GREEN DR STE 300E
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1705
Practice Address - Country:US
Practice Address - Phone:804-220-0036
Practice Address - Fax:804-597-0114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040090371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty