Provider Demographics
NPI:1912356247
Name:J GROUP COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:J GROUP COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHALANDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-665-3147
Mailing Address - Street 1:3349 COFER RD
Mailing Address - Street 2:B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-6405
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3349 COFER RD
Practice Address - Street 2:B
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23224-6405
Practice Address - Country:US
Practice Address - Phone:804-665-3147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-07
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040091041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty