Provider Demographics
NPI:1811220700
Name:EMMAUS FAMILY COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:EMMAUS FAMILY COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:703-464-0877
Mailing Address - Street 1:20915 ASHBURN RD
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5677
Mailing Address - Country:US
Mailing Address - Phone:703-464-0877
Mailing Address - Fax:
Practice Address - Street 1:20915 ASHBURN RD
Practice Address - Street 2:SUITE 235
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5677
Practice Address - Country:US
Practice Address - Phone:703-464-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-10
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002188101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty