Provider Demographics
NPI:1689736191
Name:MEDICAL & COUNSELING ASSOC INC
Entity Type:Organization
Organization Name:MEDICAL & COUNSELING ASSOC INC
Other - Org Name:MCA NETWORK
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEMBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-282-9100
Mailing Address - Street 1:1503 SANTA ROSA RD
Mailing Address - Street 2:STE 211
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229
Mailing Address - Country:US
Mailing Address - Phone:804-282-9100
Mailing Address - Fax:804-282-3266
Practice Address - Street 1:1503 SANTA ROSA RD
Practice Address - Street 2:STE 211
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229
Practice Address - Country:US
Practice Address - Phone:804-282-9100
Practice Address - Fax:804-282-3266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1249Medicare PIN