Provider Demographics
NPI:1689189318
Name:EMERGENT COUNSELING SERVICES LLS
Entity Type:Organization
Organization Name:EMERGENT COUNSELING SERVICES LLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWN ER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:
Authorized Official - Last Name:INGRAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-475-0099
Mailing Address - Street 1:4637 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8375
Mailing Address - Country:US
Mailing Address - Phone:804-475-0099
Mailing Address - Fax:
Practice Address - Street 1:4637 BRIARWOOD DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8375
Practice Address - Country:US
Practice Address - Phone:804-475-0099
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904010031261QM0850X
VA094010031261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health