Provider Demographics
NPI:1710068895
Name:ELMWOOD COUNSELING SERVICES
Entity Type:Organization
Organization Name:ELMWOOD COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:MINK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:276-623-8230
Mailing Address - Street 1:966 W MAIN ST
Mailing Address - Street 2:BROOKSFIELD SQ, STE 7
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2483
Mailing Address - Country:US
Mailing Address - Phone:276-623-8230
Mailing Address - Fax:276-525-1813
Practice Address - Street 1:966 W MAIN ST
Practice Address - Street 2:BROOKSFIELD SQ, STE 7
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2483
Practice Address - Country:US
Practice Address - Phone:276-623-8230
Practice Address - Fax:276-525-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA18641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09113Medicare ID - Type UnspecifiedMEDICARE GROUP NO.