Provider Demographics
NPI:1700987419
Name:ALPHA COUNSELING ASSO PLLC
Entity Type:Organization
Organization Name:ALPHA COUNSELING ASSO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY-JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCSW
Authorized Official - Phone:804-598-9105
Mailing Address - Street 1:PO BOX 554
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139
Mailing Address - Country:US
Mailing Address - Phone:804-598-9105
Mailing Address - Fax:804-598-6379
Practice Address - Street 1:2142 PLAINVIEW CENTER
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139
Practice Address - Country:US
Practice Address - Phone:804-598-9105
Practice Address - Fax:804-598-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904005352104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty