Provider Demographics
NPI:1669028981
Name:PROLIFIC COUNSELING GROUP LLC.
Entity Type:Organization
Organization Name:PROLIFIC COUNSELING GROUP LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENTNEY
Authorized Official - Middle Name:LASON
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-405-4201
Mailing Address - Street 1:601 DINWIDDIE ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-3613
Mailing Address - Country:US
Mailing Address - Phone:757-405-4201
Mailing Address - Fax:
Practice Address - Street 1:601 DINWIDDIE ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-3613
Practice Address - Country:US
Practice Address - Phone:757-405-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health