Provider Demographics
NPI:1265899470
Name:ENNOBLED COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:ENNOBLED COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:RENEA
Authorized Official - Last Name:GREGG-MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-252-1862
Mailing Address - Street 1:700 E 6TH ST
Mailing Address - Street 2:STUDIO L
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-5560
Mailing Address - Country:US
Mailing Address - Phone:804-252-1862
Mailing Address - Fax:
Practice Address - Street 1:3620 REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-1428
Practice Address - Country:US
Practice Address - Phone:804-252-1862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health