Provider Demographics
NPI:1881392710
Name:INTEGRATIVE COMMUNITY COUNSELING, LLC
Entity type:Organization
Organization Name:INTEGRATIVE COMMUNITY COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:804-617-1352
Mailing Address - Street 1:3907 AUTUMN MIST CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-8492
Mailing Address - Country:US
Mailing Address - Phone:804-617-1352
Mailing Address - Fax:
Practice Address - Street 1:3907 AUTUMN MIST CT
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-8492
Practice Address - Country:US
Practice Address - Phone:804-630-0006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-20
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)