Provider Demographics
NPI: | 1245860105 |
---|---|
Name: | ASSOCIATES AT LYNNHAVEN COUNSELING |
Entity type: | Organization |
Organization Name: | ASSOCIATES AT LYNNHAVEN COUNSELING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CREDENTIALING |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KIM |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | RICHARDSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 757-907-2567 |
Mailing Address - Street 1: | 101 N LYNNHAVEN RD |
Mailing Address - Street 2: | #302 |
Mailing Address - City: | VIRGINIA BEACH |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 23452-7523 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-486-6955 |
Mailing Address - Fax: | 757-486-3258 |
Practice Address - Street 1: | 101 N LYNNHAVEN RD |
Practice Address - Street 2: | #302 |
Practice Address - City: | VIRGINIA BEACH |
Practice Address - State: | VA |
Practice Address - Zip Code: | 23452-7523 |
Practice Address - Country: | US |
Practice Address - Phone: | 757-486-6955 |
Practice Address - Fax: | 757-486-3258 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-01-20 |
Last Update Date: | 2025-03-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |