Provider Demographics
NPI:1639566789
Name:INTERCEDING CONSULTANT LLC
Entity Type:Organization
Organization Name:INTERCEDING CONSULTANT LLC
Other - Org Name:INTERCEDING CONSULTANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-301-6410
Mailing Address - Street 1:1140 WILKINSON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1623
Mailing Address - Country:US
Mailing Address - Phone:804-997-7962
Mailing Address - Fax:877-333-0229
Practice Address - Street 1:5412 GLENSIDE DR STE F
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3995
Practice Address - Country:US
Practice Address - Phone:804-997-7962
Practice Address - Fax:877-333-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-15
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1639566789Medicaid
VA1639566787Medicaid