Provider Demographics
NPI:1336917525
Name:CONCRETE ROSES COUNSELING AND CONSULTING
Entity Type:Organization
Organization Name:CONCRETE ROSES COUNSELING AND CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WHITLOW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-827-9071
Mailing Address - Street 1:11237 MAGILL TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-6150
Mailing Address - Country:US
Mailing Address - Phone:540-827-9071
Mailing Address - Fax:
Practice Address - Street 1:11237 MAGILL TERRACE DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-6150
Practice Address - Country:US
Practice Address - Phone:540-827-9071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health