Provider Demographics
NPI:1104255678
Name:ATHALIA EASON, LLC
Entity type:Organization
Organization Name:ATHALIA EASON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ATHALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CRC
Authorized Official - Phone:540-656-3662
Mailing Address - Street 1:5365 DICKERSON RD
Mailing Address - Street 2:
Mailing Address - City:PARTLOW
Mailing Address - State:VA
Mailing Address - Zip Code:22534-9609
Mailing Address - Country:US
Mailing Address - Phone:540-656-3662
Mailing Address - Fax:
Practice Address - Street 1:1900 BYRD AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3033
Practice Address - Country:US
Practice Address - Phone:540-656-3662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005618101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty