Provider Demographics
NPI:1760789200
Name:EXTREME COUNSELING SOLUTIONS
Entity Type:Organization
Organization Name:EXTREME COUNSELING SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEATRICE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:DELK
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:804-382-0098
Mailing Address - Street 1:811 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-3329
Mailing Address - Country:US
Mailing Address - Phone:804-382-0098
Mailing Address - Fax:
Practice Address - Street 1:811 LOGAN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3329
Practice Address - Country:US
Practice Address - Phone:804-382-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1394251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health