Provider Demographics
NPI:1194348557
Name:IMMERSE & EMERGE COUNSELING
Entity type:Organization
Organization Name:IMMERSE & EMERGE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:434-660-5848
Mailing Address - Street 1:2413 HAWTHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2905
Mailing Address - Country:US
Mailing Address - Phone:434-660-5848
Mailing Address - Fax:
Practice Address - Street 1:10617 KETTERING DR STE 113
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226-4900
Practice Address - Country:US
Practice Address - Phone:866-977-9067
Practice Address - Fax:866-977-9159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty