Provider Demographics
NPI:1669556585
Name:FOOTSTEPS COUNSELING CENTER
Entity type:Organization
Organization Name:FOOTSTEPS COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUCKOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:804-715-3215
Mailing Address - Street 1:6851 COURTHOUSE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-5308
Mailing Address - Country:US
Mailing Address - Phone:804-715-3215
Mailing Address - Fax:804-715-3233
Practice Address - Street 1:6851 COURTHOUSE RD STE 300
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-5308
Practice Address - Country:US
Practice Address - Phone:804-715-3215
Practice Address - Fax:804-715-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA738019000OtherMAGELLAN
VA010198593Medicaid
VAC09140Medicare ID - Type Unspecified