Provider Demographics
NPI:1184150781
Name:EMBRACE COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:EMBRACE COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-819-4353
Mailing Address - Street 1:3524 BRAMBLETON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-6528
Mailing Address - Country:US
Mailing Address - Phone:540-819-4353
Mailing Address - Fax:
Practice Address - Street 1:3524 BRAMBLETON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-6528
Practice Address - Country:US
Practice Address - Phone:540-819-4353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty