Provider Demographics
NPI:1700449816
Name:BEYOND THE IMAGE CHRISTIAN COUNSELING, LLC
Entity Type:Organization
Organization Name:BEYOND THE IMAGE CHRISTIAN COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:804-369-3005
Mailing Address - Street 1:10801 GREENFIELD LANE
Mailing Address - Street 2:
Mailing Address - City:AMELIA COURT HOUSE
Mailing Address - State:VA
Mailing Address - Zip Code:23002
Mailing Address - Country:US
Mailing Address - Phone:804-369-3005
Mailing Address - Fax:803-369-3005
Practice Address - Street 1:6709 LAKE HARBOUR DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2083
Practice Address - Country:US
Practice Address - Phone:804-369-3005
Practice Address - Fax:804-369-3005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty