Provider Demographics
NPI:1740780345
Name:GOOD MOURNING COUNSELING & CONSULTING LLC
Entity Type:Organization
Organization Name:GOOD MOURNING COUNSELING & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOWCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:MSED, LPC, NCC-GC-C
Authorized Official - Phone:757-572-4609
Mailing Address - Street 1:1324 DEBBS LN
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-8202
Mailing Address - Country:US
Mailing Address - Phone:757-436-4368
Mailing Address - Fax:
Practice Address - Street 1:3630 S PLAZA TRL STE 210C
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-3366
Practice Address - Country:US
Practice Address - Phone:757-572-4609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007162261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health