Provider Demographics
NPI:1336417419
Name:TRUST COUNSELING SERVICES
Entity Type:Organization
Organization Name:TRUST COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PLC
Authorized Official - Phone:757-892-0467
Mailing Address - Street 1:2532 FARMWORTH TRAIL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456
Mailing Address - Country:US
Mailing Address - Phone:757-892-0467
Mailing Address - Fax:
Practice Address - Street 1:2532 FARMWORTH TRL
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-7857
Practice Address - Country:US
Practice Address - Phone:757-892-0467
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1334251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health