Provider Demographics
NPI:1902357809
Name:INNER SELF COUNSELING AND COUNSULTING LLC
Entity Type:Organization
Organization Name:INNER SELF COUNSELING AND COUNSULTING LLC
Other - Org Name:INNER SELF COUNSELING AND CONSULTING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MS
Authorized Official - First Name:LAKESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-919-0902
Mailing Address - Street 1:8008 HEAVENLY VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23231-8954
Mailing Address - Country:US
Mailing Address - Phone:804-919-0902
Mailing Address - Fax:804-795-5897
Practice Address - Street 1:8008 HEAVENLY VALLEY DR
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23231-8954
Practice Address - Country:US
Practice Address - Phone:804-919-0902
Practice Address - Fax:804-795-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003863251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184895484OtherINDIVIDUAL NPI NUMBER
VA600875758Medicaid