Provider Demographics
NPI:1063669414
Name:THERAPEUTIC IN HOME COUNSELING
Entity type:Organization
Organization Name:THERAPEUTIC IN HOME COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE SUPERVISOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-640-2101
Mailing Address - Street 1:1949 VESONDER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2933
Mailing Address - Country:US
Mailing Address - Phone:804-722-1185
Mailing Address - Fax:877-879-6336
Practice Address - Street 1:1949 VESONDER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2933
Practice Address - Country:US
Practice Address - Phone:804-640-2101
Practice Address - Fax:877-879-6336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1261101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty