Provider Demographics
NPI:1891227641
Name:IVY COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:IVY COUNSELING CENTER LLC
Other - Org Name:IVY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPC/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARSHEIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-312-7469
Mailing Address - Street 1:308 NEW CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2415
Mailing Address - Country:US
Mailing Address - Phone:804-312-7469
Mailing Address - Fax:804-957-4535
Practice Address - Street 1:20 E TABB ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-4541
Practice Address - Country:US
Practice Address - Phone:804-312-7469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006383251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366982936Medicaid