Provider Demographics
NPI:1750463618
Name:ASSOCIATES IN COUNSELING AND FAMILY THERAPY, INC
Entity Type:Organization
Organization Name:ASSOCIATES IN COUNSELING AND FAMILY THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:POLLARD
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT, MAC, NCC
Authorized Official - Phone:804-520-1655
Mailing Address - Street 1:PO BOX 579
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-0579
Mailing Address - Country:US
Mailing Address - Phone:804-520-1655
Mailing Address - Fax:804-520-8595
Practice Address - Street 1:107 W ELLERSLIE AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1513
Practice Address - Country:US
Practice Address - Phone:804-520-1655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101YM0800X, 101YP2500X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO8104Medicare UPIN
VACO8104Medicare PIN