Provider Demographics
NPI:1629835731
Name:VIRCILLE COUNSELING & CONSULTING SERVICES, PLLC
Entity Type:Organization
Organization Name:VIRCILLE COUNSELING & CONSULTING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC-MHSP/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:931-809-2533
Mailing Address - Street 1:4237 N WOODSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1651 WILMA RUDOLPH BLVD STE 204
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-6783
Practice Address - Country:US
Practice Address - Phone:931-809-2533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty