Provider Demographics
NPI:1790152775
Name:FAMILY COUNSELING CENTER FOR RECOVERY
Entity Type:Organization
Organization Name:FAMILY COUNSELING CENTER FOR RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:ADCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-735-9350
Mailing Address - Street 1:905 SOUTHLAKE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3955
Mailing Address - Country:US
Mailing Address - Phone:804-419-0492
Mailing Address - Fax:804-419-0500
Practice Address - Street 1:905 SOUTHLAKE BLVD STE C
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3955
Practice Address - Country:US
Practice Address - Phone:804-419-0492
Practice Address - Fax:804-419-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006241261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder